May 13, 2020
In this time of social distancing, communication between patients with cardiac disease and physicians has been transformed in an effort to decrease disease exposure. Patients and their families face an immensely stressful time whenever undergoing cardiothoracic surgery, but during the COVID-19 pandemic, the traditional support mechanisms and routes of communication used throughout the hospital stay as well as before and after surgery have been greatly curtailed, giving rise to other means of communicating and providing support. It also is important to note that restrictions are continually being modified in response to the dynamic nature of the pandemic, so patients and their families should be prepared.
Before delving into the specifics of how communication has changed, it is important to recognize that the limitations placed on visiting policies and other traditional means of support and communication are driven by the ultimate goal of patient and staff safety. Each institution has examined the evidence related to the COVID infection and its spread, the resources and risk profiles in their communities, and the current status of exposure in their hospitals in order to convene on recommendations to preserve the safety of the patients and staff.
Limiting exposure applies not only to the community at large, but perhaps even more importantly, to a location like a hospital where relatively close quarters are kept. Furthermore, many cardiothoracic surgery programs, and particularly congenital cardiac surgery programs, are staffed by a small group of individuals whose skillsets cannot be easily replaced. Exposure or infection to even one or two of these individuals could shut down an entire program. Therefore, it is important to keep in mind that these measures are ultimately for the protection of you, your family, the staff, and the community at large.
Prior to the procedure, be sure to clarify the specifics of who is allowed to visit and when, and how the surgeon and other physicians will be communicating with your family. Setting accurate expectations allows you and your family to mentally prepare for the postoperative care phase, as well as discuss mechanisms for communication, both among yourselves and between your family and physicians.
Physician Communication with Families
One of the most critical discussions that the surgeon has during your hospital stay is the one that occurs with your family immediately after surgery. At this point, you as the patient are still asleep, but your family is briefed. The surgeon will discuss all that occurred during the operation and the expected progression over the next several days. In the past, this conversation has occurred in person with multiple family members present. However, in these times, many hospitals have not allowed visitors for adult patients. Therefore, surgeons have developed other methods for this conversation to occur. Some will meet the family at a hospital entrance to provide a face-to-face conversation. Others will participate in a video chat with family members, including as many who would like to be involved as possible. And others will rely on phone conversations with family members. Make sure you talk to your family about how you would like to handle this conversation and prepare any appropriate technology (e.g., Zoom or other mechanisms).
Similarly, throughout the postoperative course, physicians and other staff traditionally update the family in person, as they are often bedside at various points throughout the day. However, during these times, updates provided to families occur through phone calls or video chats with you and the physician. You can prepare for this by asking when the physician may be expected to visit the patient and be prepared for a video call during that window of time, or simply ask that the physician call you with an update.
Patient Communication with Families
Given the current restrictions on visitors, many adult patients will not be allowed to have family members physically present during their postoperative hospital stay. Clarifying the limitations in place at your hospital prior to surgery can help you and your family mentally prepare and develop mechanisms of “virtual” support. Many of our patients use FaceTime and Zoom to interact with their families frequently throughout the day. It can be helpful to talk as a family prior to surgery about ways that the family can best support you, such as a group FaceTime at a certain time each day. You also should brainstorm about other ways that your family and friends can provide “virtual” support during this time.
Communication and Support for Pediatric Patients
Pediatric patients undergoing surgery during the COVID crisis also face restrictions related to communication and support. One of the most difficult aspects to this is the visitor policy. Clearly, a child or infant undergoing surgery and taken out of his/her home environment requires the support of family during the hospital stay. The challenge is how to provide such support while also minimizing exposure.
Some institutions are allowing two caregivers to be present throughout the hospital stay, while other hospitals allow two caregivers to visit the child during the hospital course, but only one caregiver at a time to decrease exposure risk. This may even include allowing only one caregiver to:
- Be present in the preoperative area before the child goes back to surgery
- Wait in the hospital during the operation
- Speak with the surgeon after the operation
Families should specifically ask what a given institution’s policy is so that they can prepare for how to best support one another and the child during this time. Some caregivers have preferred to wait together at a location near the hospital until the surgeon is ready to speak to family, and then have one family member return to the hospital to speak face-to-face with the surgeon while others join via phone. Others have decided to have one person wait at the hospital and family members provide virtual support for that person during the operation.
Communication and Outpatient Management
Many of our patients with cardiothoracic diseases are being managed as outpatients. Some of these patients have been advised that they may need surgery in the near future, but the timeline has not yet been determined.
While in the past such patients have had face-to-face visits with their cardiologists and other specialists, and often with a surgeon to discuss planning for an operation, face-to-face visits now have been minimized. Many of these patients are being managed with “virtual” visits, in which clinicians determine as much as possible regarding symptoms and clinical status via video visit. Traditional clinical exams are not able to be performed. Based on the virtual visits and any indicated testing, decisions are made about how these patients should be seen and the appropriate course of action and/or timing of surgery. In some cases, the plan is clear cut and the preoperative visit with the surgeon also will be a virtual visit. Overall, the satisfaction with this type of management has been relatively high, and patients and their families have understood the rationale behind the change.
Social distancing and minimizing exposure remain fundamental to the fight against COVID-19. Unfortunately, this has radically altered communication and support for patients undergoing cardiothoracic surgery. Discussing the specifics of the hospital’s policies related to this is an essential step to setting expectations, planning how communication and support can be given, and brainstorming creative ways to help you and your family during this difficult time.
The opinions expressed in this article are those of the author and do not necessarily reflect the views of The Society of Thoracic Surgeons.
The STS mission is to advance cardiothoracic surgeons’ delivery of the highest quality patient care through collaboration, education, research, and advocacy.