Intended for healthcare professionals

Letters Covid-19 communication aids

Covid-19 communication: planning ahead to help inpatients when key contacts can’t be present

BMJ 2020; 370 doi: (Published 18 September 2020) Cite this as: BMJ 2020;370:m3671
  1. Joanne Wilson, Macmillan consultant nurse palliative care, Royal Free Group advance care planning clinical pathway group lead,
  2. Jane Hawdon, medical director, consultant neonatologist,
  3. Sarah Lally, acute liaison nurse—learning disabilities,
  4. Danielle Wilde, group lead for dementia
  1. Royal Free London Hospitals NHS Foundation Trust, London NW3 2QG, UK
  1. jo.wilson8{at}

We thank Gray and Back for their article on communication and covid-19.1 Conversations in our trust have increased and been complicated by the use of personal protective equipment. This particularly affects professionals and patients who are deaf2 but also affects those with other sensory impairments, dementia, or learning disabilities.

Visiting has been restricted in UK hospitals,3 with a move towards telephone and video consultations.4 This is complex work, especially when phoning patients or families who are experiencing domestic abuse5 or when there are child safeguarding concerns.

There are eight different categories of communication to consider for inpatients when key contacts cannot be present: independent communication by patients with mental capacity and their key contacts; daily supported communication of patients who lack mental capacity or who have communication challenges with their key contacts for social stimulation and reassurance; daily update of the key contact by the ward team; update of the key contact as required, by the doctor, with substantial change in medical treatment; patient and key contact meeting for best interests decision making and complex discharge planning; supported virtual visiting of dying patients, alongside direct visiting by the key contact; regular updates regarding those who are dying from clinicians to key contacts; support of virtual visiting of those who have died if the patient has given consent or there is a best interests decision.

Any of these might require an interpreter, signing expert, or specialised technology. Reflecting on these categories enables clinicians to plan ahead and consider what needs to be communicated, who to lead the call, the most appropriate mode, the time and place required, and who else needs to be on the call.

Organisations should consider educating staff to use phone and video calls; supporting patients and key contacts who are children or have learning or communication difficulties; the management of challenging situations, such as distressed relatives; and guidelines for consent for filming, transmission, and storage of images and video.


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