Here are Some Quick and Easy Methods for Healthcare Providers to Improve Communication with COVID-19 Patients with Limited Ability to Speak

By Adina Bradshaw, MS, CCC-SLP, ATP
Speech-Language Pathologist, Assistive Technology Center at Shepherd Center

The American Hospital Association estimates that throughout the COVID-19 (coronavirus) pandemic, 960,000 patients will require intubation and the use of a ventilator. These lifesaving pieces of equipment will help thousands of patients breathe. Being intubated involves a tube passing between the vocal cords into the windpipe; therefore, it can make it very difficult for patients to communicate verbally.

For decades at Shepherd Center, we have been caring for patients with spinal cord and brain injury who are unable to speak due to intubation, vocal cord paralysis, tracheal stenosis and other conditions. They all have this in common – the desire to communicate. The inability for a patient to communicate can add extra stress to a patient who is already in crisis mode. In fact, several studies have reported that a patient's inability to communicate can cause or further exacerbate feelings of psychological and emotional distress, anxiety, panic, fear, frustration and helplessness. Looking at it another way, a patient's ability to communicate when intubated also can decrease complications stemming from a lack of communication with members of their healthcare team.

With the rate of intubation on the rise due to COVID-19, I have received several requests from healthcare providers and peers around the country asking for advice and resources on how to help hospitalized patients with limited ability to speak. Here are my suggestions for helping people with COVID-19 find their voices.

Keep it Simple – While we all love our high-tech communication tools, sometimes simpler is better. If a patient is intubated and unable to speak, but is still able to use his or her hands, try to communicate with pen and paper. You can also use a whiteboard and dry erase markers. A Boogie Board LCD writing tablet is also a good option if you have access to one. Of course, make sure to disinfect anything you use to communicate.

Use Yes and No – Establish a sound system of “yes” and “no” based on the patient’s capabilities. This can be as simple as thumbs up for “yes” and thumbs down for “no.” Other options are to nod your head up and down for “yes” and side to side for “no” or blink once for “yes” and twice for “no.”Then, ask targeted questions to investigate what the patient may need. Always confirm that what you think the patient is saying is correct. Make a note in the patient’s record or in the patient’s room of what their “yes” and “no” system is so that other providers can use it as well. Once you establish your yes and no system, communication will become much more manageable.

Communicate with a Board – Try using a communication board. These boards can simply say “yes” or “no,” or they can include various words such as “pain,” “thirsty,” “I’m cold,” or “What is that medication?” To use one, you'll want to:

• Print out and laminate the communication board.
• Establish a reliable “yes” and “no” system with the patient.
• Place the board so that it is visible to the patient.
• If the patient can point, have them point at what they’re trying to say on the board.
• If they cannot use their hands to point, point to each row in order and ask: “Is it in this row?” or say “Row 1,” “Row 2,” etc.
• Once the patient makes a row selection, point to each successive box in the row and ask, “Is it this one?” or read the text in each box.
• Be sure to modify your speed according to the individual patient’s needs.
• Disinfect the board.

Test Technology – There are dozens of mobile apps available to help with non-verbal communication, including Vocable, which tracks head movements to facilitate communication. There are also apps that will act as a whiteboard. When there is time for training on both the patient and provider side, these apps can be invaluable. But in a time when hospitals and care providers are likely overburdened, simpler might be better. Also, keep in mind that in many healthcare facilities, Wi-Fi coverage may be spotty, which makes many apps and online tools difficult and frustrating to use. If this is the case, see above and keep it simple.

During these unprecedented times, I understand that there may be no time to use some of these tools. If that’s the case, I recommend simply using the whiteboard or writing the alphabet on a piece of paper.

For additional information regarding communication strategies for hospitalized patients with limited ability to speak, please visit these resources:

• Patientprovidercommunication.org
• COVID-19 Communication Board
• Partner Assisted Communication Video
• Vocable App

For more information, you can contact me at adina.bradshaw@shepherd.org.

ADINA BRADSHAW, MS, CCC-SLP, ATP, is a speech-language pathologist in the Assistive Technology Center at Shepherd Center. She has worked at Shepherd Center for more than a decade. She has a bachelor’s degree in speech pathology and audiology and a master’s degree in speech pathology from Miami University in Oxford, Ohio. Bradshaw also has a teaching certificate, multiple state speech pathology board certifications, ASHA certification and RESNA assistive technology certification.