 Hi, everybody. This is Donna Prosser with the Patient Safety Amendment Foundation here to bring you another COVID-19 update. Today, we're going to be talking about improving communication with hospitalized patients. And I'm very excited to be joined today by Dr. Todd Lecky and by Dr. Rachel Bermaldi, both from the United Kingdom. Welcome, and thank you so much for joining us today. Thank you, thank you for having us. Thank you. I'd love for you to tell us a little bit about yourself. Can we start with Rachel? Yeah, so I'm Rachel Bermaldi. I'm an NHS anesthetist and founder of CardMedic, which we'll be talking about today, which is a communication tool to help improve communication through the PPE barrier. Excellent, thank you. And Todd, tell us a bit about yourself. So I'm Todd. I'm also an NHS anesthetist, and I've got some kind of firsthand experience of using CardMedic in my clinical practice, working in anesthetics and intensive care. Great. Well, this is a really exciting tool. And Rachel, I know that you created this not that long ago. Can you tell us a little bit about what inspired you to create it and tell us a little bit about the product? Sure, so I am currently on maternity leave. I've been desperate to get back to work and do something to help. Unfortunately, I can't be on the front line, but I've been keeping up to date with friends and colleagues working at the front line and been reading the news avidly. So I came across an article about a patient who'd been to the ICU with coronavirus. Felt terrified because he couldn't understand what the staff were saying to him through the PPE, so the face masks, the visor, the hoods, et cetera. And so I thought about surely there's a simple way that staff could just write down their message on a piece of paper and show it to the patient, which happens anyway in intensive care settings. But it's unsustainable in the current pandemic as a communication tool on a daily basis. So I thought about maybe an A to Z list or A to Z list of topics as to, for example, if I were to be looking after a patient under these circumstances, what would I be talking to them about? I've got experience in anesthetics and critical care over the last decade. So I just thought of the common topics that I might want to address, anything from airway to allergies, to any issues with breathing, medications, in case I needed an operation. And I just wrote down all the content. Within 72 hours, we'd launched a website, cardmedic.com, and just thought initially I would share it with some friends and then a few days later, joined Twitter and it kind of went from there. So it's essentially a website. It's also available as an app on Google Play or Apple Store. It's all free and you just visit it, you scroll through the list, decide which topic you'd like to talk to your patient about, click on the topic, show the patient the screen and then they can read it and then respond to you in return. And then it's got lots of little extra features and things I can talk about as well, but that's the kind of background to it and the basis for it. That's great, what an excellent tool. And Todd, what kind of communication were you experiencing in your organization that inspired you to start using this tool? So with COVID-19, it's obviously a disease that predominantly affects the respiratory system and we have to provide ways to kind of support the patient's respiratory system and one of the ways we do that is with something called non-invasive ventilation, which is where we either use a mask or essentially a hood over the patient's head to provide increased rates of oxygen delivery. And that's a very effective way to support a patient's breathing, but kind of a side effect of that is that the patient's hearing can be affected because the flow rates, so the rates of the oxygen kind of flowing into the patient's face are very high and that can cause excess noise and impair a patient's hearing. So I think there's two issues with COVID-19. One, obviously we're wearing personal protective equipment, so we're wearing a face mask advisor and that inhibits some kind of non-verbal communication tools that we would normally have. And then the second is obviously the patient can't hear as they would not ordinarily once they've started non-invasive ventilation. So it's kind of, it's addressing, card medic is addressing those two problems by providing a way to communicate with the patient that bypasses kind of the hearing and relies on kind of visual cues. And also it's just provides real clarity. So the prompts are very clear and concise. And I think that's what you need when you're treating a critically ill patient. You know, their ability to understand is often impaired due to that critical illness. And so if you have something that's very clear, concise, and to the point that they can read, then that can convey a lot of information very quickly and help aid their understanding. And as Rachel says, hopefully mitigate any fear that they might be experiencing through the fact that they're not quite understanding what's going on. That's great. Now, how do you actually use it in the clinical setting? Do you bring the computer with the website up into the room or do you bring the app into the room? Yeah, so I think we've been really lucky within the organization I work in. And I think this is reflected across the NHS within the UK is we've had the provision of a lot of iPads and tablet devices which have been able, because of infection control issues, devices that are in the kind of what we call the red area. So the area where patients with COVID-19 are, which are higher infectious infection risk, devices in that area can't leave the area. So what a lot of organizations have done is they've invested in tablet devices like the iPad. And then you can just log on to the internet, use just a standard browser on any tablet device and access the CardMedic website very quickly. Literally within 30 seconds and you're on the device. And it's a very simple, clear website. So I think it's very easy to navigate even if you're not particularly familiar with the website. The first time I used it, I found what I needed very quickly. Great, great. Now, Rachel, I know you're planning to study this further. Can you tell us a little bit about what you're working on there? Yeah, so we are trying to demonstrate the effectiveness of CardMedicate, improving communication through that barrier that the PP creates exactly as Todd explained. So I've partnered with the University of Brighton and Brighton and Sussex University Hospital's NHS Trust. We have done a pilot study using 10 simulated patients to look at the effectiveness of CardMedic at improving communication and looking at the patient's experience and their anxiety levels and their level of understanding as well. So analysis is underway this week, but the preliminary results do show that CardMedic does significantly improve the effectiveness of communicating. As Todd said, a variety of topics, but just in a really simple, concise way. So the results of that will be out. And then we're looking at partnering up with universities, sorry, university hospitals in the US and also in Spain as well, big teaching hospitals to do co-pilot studies there to assess the same kind of thing. Great. And Todd, what lessons do you think that clinicians can take from the communication issues we're having during this pandemic? So I think probably the first is how reliant we are on kind of non-verbal communication. So the importance of, you know, when you're communicating with a patient, you know, establishing eye contact and, you know, being aware of the limitations that wearing PPE kind of involves because you lose, I think, a significant spectrum of your ability to communicate. So that's the first thing. And then I think the second is just how much complex information we try to impart on critically unwell patients in a very short period of time when we're trying to, you know, assess them and treat them. Certainly early on in their journey in the hospital when they're kind of first coming into hospital and there's a lot going on very quickly. So I think card medics are very useful at streamlining communication in those situations. And I think it's not only kind of a practical tool that you can use when, you know, seeing patients, managing patients, but also, you know, as an education tool just to think about some of the processes that you try to explain as a doctor. And I think card medic can act as kind of almost like a guide on best practice and suggest, you know, how can you get across information in a concise and efficient way that isn't overwhelming to the patient but kind of informs the patient and lets them feel that they've got some control and awareness of what's going on, you know, when they first come into hospital. Great. Rachel, what improvements or enhancements do you intend to make to card medic moving forward? Well, I think we've got a lot of features already that are available that we're expanding on. So for example, it is already translated into 10 languages. And that's being done, originally that was a service donated by a company called Weglow but we've now got another company, Language Connect, which are doing that professionally for us with humans. So it'll be more accurate. And then I've got lots of members of the public who've also come forward to translate as well. And we're always looking for new people to help. So there's now a system where they can go in, do your translations and then it comes to us to quality check and then it goes out. So the translations are expanding. We are also working with the Royal Association of the Deaf People, Signly, Sign Live, Helen Foates, Translator and various other people who've come forward to generate lots of British Sign Language videos. So we're going to be incorporating the Sign Language side. And then I'm working with a group of speech and language therapists, learning disability nurses and communication specialists at creating a really accessible version of the website as well. So it has lots of images, illustrations and signs on it. So that will be in the next few weeks. Hopefully we'll be launching the accessible side. So those are the three big areas that we're working on. We've got version two of the app coming out shortly. And we are going to be integrating those changes onto the website as well. So the features that we've got are where the clinician can upload their name and photo to the app or the website. You can take a selfie or you can upload something from your camera roll. And as Todd said, a lot of that information is lost behind the mask, a lot of non-verbal communication in the face of who's looking after the patient, it's lost. So that can be made available and you can show your patient your picture and your name on your phone, where you're working and the patient can see exactly who's looking after them behind the mask. So that's a really nice feature. And the other aspect that we're working really hard on is we've got a free note section. So whilst the website has a lot of content, there is a lot more to add. And there will be things on that might not be on the website that patients and staff might want to talk about. So that free note section is a place where the staff or the patients can type messages back and forth to each other and it can be translated. It can also be read aloud. So we have a read aloud function in the site for partially sighted or blind patients. So a patient who can't read for any reason or has visual impairment, the page can be read aloud to them. So we're integrating that into that free text section. So it almost, it's a translate app embedded within the site and the app itself. So you can have a conversation, we'll do speech to text. You can talk into the phone, it will automatically translate. So you can have without the need for a translator to be present. So you can have a translated conversation live with between staff and patient as well. So that's what we're working on and that will come out in version two. So a lot more functionality to add. And hopefully really helpful features to come out and we're just constantly looking for feedback. And we're reviewing and revamping all the time. We just need more hours in the day at the moment. That's great. What an excellent tool. Well, thank you so much for being here today and sharing this great information. We're gonna share this with our network and we're gonna share your website. You mentioned you were interested in feedback. Is there a place on your website where people can share that? Yeah, absolutely. So you go to www.cardmedic.com and there's a section at the bottom that says contact us or there's an ideas page that comes through to the same place. Or you can tweet at cardmedic and get in touch or emails info at cardmedic.com. Great. And what about the app? If somebody was interested in that, can it be downloaded from your website? Yep, there's links from the website. So there's a link to the Apple Store and link to Google Play or you can just go straight to the stores and you just type in cardmedic and it comes up there. So you can download it. It's all free. Everything is free. Great. Wow, well, that is an excellent tool and I know that people across the world are really gonna be happy to use this. So thank you both for taking the time to talk with us today. And I hope that we will have you back soon in a couple of months to tell us about what great enhancements you've made. Thank you. Thank you so much for having us. All right. Thank you.