Using augmentative communication to support COVID-19 patients

Illustration of doctor in front of bed with charts showing symbols to help COVID patients communicate
Bedside patient-provider communication: a basic patient right pioneered at Boston Children's. (Image: Adobe Stock/Sebastian Stankiewicz, Boston Children’s)

People with COVID-19 on a ventilator are unable to speak to express their needs, which can complicate their care and lead to poorer outcomes. The Augmentative Communication Program at Boston Children’s Hospital is supporting hospitals around the nation and around the world by helping them communicate with these critically ill patients in the hopes of improving their fate.

One way Boston Children’s is having a widespread impact is through the Vidatak E-Z board, which is a communication board that contains a suite of symbols created by John Costello, MA, CCC-SLP, director of the Augmentative Communication Program.

Symbol sets for COVID-19 patients

Costello developed the symbols three decades ago in conjunction with some of our patients in the intensive care unit (ICU) to give them a way to express their unique needs, so clinicians can respond to them at the earliest stage. The symbols convey the type of information patients in the ICU need to communicate with clinicians, such as: I need to be turned or I need to be suctioned.

“When we first created these symbols, many of our nurses saw that this allowed them to provide better patient care. They no longer had to wait for vital signs to change since patients now had a way to say they needed something,” Costello says. “This early work laid the foundation for the Vidatak board that is now being used as one of the tools for COVID-19 patients worldwide,” he explains. 

Boston Children’s ultimately licensed the symbols to Vidatak to share them with a broader audience. Now during COVID-19, hospitals all around the world are using these boards with patients unable to speak on their own. Costello points out that this is one tool of many that are available to help patients and staff communicate effectively.

Influencing national communication efforts

Through his work at Boston Children’s, Costello also was part of a small group that helped the Joint Commission to create its first set of standards on how to communicate with patients who need alternative options. This is especially significant since communication is increasingly recognized as a critical part of providing safe and high-quality care.

In response to the coronavirus crisis, this guiding group was recently expanded to create the patient-provider communication COVID-19 task force. The task force is a national effort that brings together speech-language pathologists, nurses, and psychologists from across the United States to improve patient-provider communication during COVID. 

Providing resources for COVID-19 patients

Rachel Santiago, MS, CCC-SLP, clinical coordinator of Boston Children’s Inpatient Augmentative Communication Program, is very involved in the national task force efforts. She is helping to bring communication needs to the forefront of national efforts to support COVID-19 patients on ventilators and provide them with ways to communicate their needs so clinicians can respond at the earliest stage. The group makes available a variety of free resources and tools that COVID-19 patients and families can download and print to communicate. These tools also play an important role in preventing patients from feeling isolated and promoting socialization.

Drawing on Boston Children’s augmentative communication efforts

To further help other groups benefit from Boston Children’s expertise in augmentative and alternative communication efforts, Santiago also draws on Boston Children’s experiences to mentor clinicians around the world who are interested in developing an augmentative communication service in their own institutions. This is enabling many general hospitals caring for an influx of patients who are mechanically ventilated to build on our experiences and find new ways to communicate with this population.

Customizing our approach for each patient

In the COVID pandemic, a health care provider in a gown, gloves and masks using a communication board with symbols with a young patient.
Santiago creates communication boards customized for each patient’s unique needs.

“At Boston Children’s, we have a dedicated service that allows us to customize our own communication strategies for each patient’s unique needs,” Santiago says. As a result, she says when she and her colleague Meredith Sager, SLP, work with COVID-19 patients and others, they are using some of the original symbols Costello created for the Vidatak board, as well as some of the symbols from the task force resources, and they combine these with other tools and resources to ensure every child receives the highest quality care.

Get answers about COVID-19 and learn more about how we are supporting patients and families.

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