Video calling on a COVID-19 ward

In March 2020, our acute admissions ward in North London became our trust's allocated isolation ward for psychiatric patients with confirmed or suspected COVID-19 infection. The pandemic created a variety of unprecedented challenges across the trust, one of these being that visitors, including healthcare professionals from community teams, were no longer permitted access to the in-patient wards.^{Reference Teixeira AL, Spadini, Pereira-Sanchez, Ojeahere, Morimoto and Chang1}

Many patients on the wards no longer had regular contact with their friends and family. This created anxiety for carers and relatives, and they reported dissatisfaction with telephone call updates from ward staff. In turn, the patients reported feeling increasingly disconnected from their families.

The Attend Anywhere software provided a solution to these types of problem. A video consulting platform that is both confidential and recommended for use within the National Health Service (NHS), Attend Anywhere allowed patients to have face-to-face video conferences with family and friends, as well as allowing healthcare professionals to attend patient meetings remotely.^{Reference Duerr2} The use of Attend Anywhere removed some of the unprecedented barriers created by the COVID-19 pandemic, and we found that both patient and next of kin satisfaction improved.

Video consultation software

The software was easily used on the ward. Attend Anywhere accounts were created for staff with their professional email address. Family members and healthcare professionals were given an URL link to the healthcare professional's Attend Anywhere account and could join the video consultation. The URL link was given either over the phone or via email. The attendees used the URL link and entered a virtual waiting area until the healthcare professional accepted the video call. (See Fig. 1, where doctors on Sapphire ward are using the Attend Anywhere software during a patient consultation).

Fig. 1 Dr Moslehi and Dr Leveson using Attend Anywhere.

Expanding video calling across the trust

The Attend Anywhere video consultation platform was not widely used by healthcare professionals in our NHS trust before the COVID-19 pandemic. The necessary safety measures in response to the pandemic led to restrictions in the level of contact that healthcare professionals had with relatives and colleagues. Our team therefore embarked on a quality improvement project to promote video consultation via Attend Anywhere as a means of enhancing patient care.^{Reference Yellowlees3}

Information was provided to other teams in the form of brief in-person teaching sessions and written leaflets. A list of interested staff members was compiled, and these individuals were proactively contacted by the trust lead to set up new accounts. This hands-on approach continued with email prompts and face-to-face support for technology or IT difficulties.

Attend Anywhere usage data were requested from the trust lead every 2 weeks to evaluate the increase in its uptake and ongoing use.

Challenges and solutions

One of the greatest obstacles to Attend Anywhere usage was poor internet connection on the wards and lack of staff access to devices such as laptops and iPads. Many staff members reported that they had to use their own smartphones. Other challenges included difficulties of relatives or carers in using the technology, or their lack of access to a suitable device.

Participants in the quality improvement project raised the issue of poor internet connection and identified it as a major factor in prevention of video consultation. Therefore, the problem of poor internet connectivity was reported to the trust's IT department by the team and was subsequently solved. The quality improvement team also spoke to ward managers and asked whether they could order more devices for staff to use for video consultations.

Positive factors leading to an increased uptake

Factors that enabled implementation of Attend Anywhere across the trust were the positive feedback and interest of staff members, the preference voiced by family members for its use in place of telephone calls, and the timesaving nature of video consultation. The collective experience throughout our hospitals was that Attend Anywhere facilitated the containment of the COVID-19 virus, as more patients were willing to self-isolate when they had a means of closely communicating with their friends and family.

Scope for international use of telepsychiatry

The use of telepsychiatry during the COVID-19 pandemic on our ward has highlighted areas in which its use could be further expanded internationally. Many rural areas with a low population density are unable to afford or justify secondary care psychiatric input;^{Reference Aref-Adib, McCloud, Ross, O'Hanlon, Appleton and Rowe4} these areas could be linked to psychiatry clinics in regional centres using video consultation platforms such as this one. Potential barriers to this include limited access to technology in rural areas of less economically developed countries. Given the significant difficulties with the internet connection in our hospital, it is likely that this would be a potential barrier to the uptake of telepsychiatry worldwide. Other potential barriers to an effective implementation of telepsychiatry nationally as well as internationally include insufficient resources and lack of familiarity with the required technology.^{Reference Aref-Adib, McCloud, Ross, O'Hanlon, Appleton and Rowe4}

The use of telehealth and its effectiveness are not limited to the pandemic. There is room for further development to enable healthcare professionals from two or more remote sites, nationally as well as internationally, to connect and contribute to patient care.^{Reference Ryan5}

Adaption to telepsychiatry in general is reliant on a variety of factors. The teleconsultation should be simple, familiar and patient-centric, as explained by Attend Anywhere founder Chris Ryan in an article about telehealth.^{Reference Ryan5}