Dying patients should be encouraged to say goodbye to their families over Skype during a major coronavirus outbreak, according to official guidance issued to NHS hospitals.
Families should be restricted from visiting their relatives in intensive care to avoid spreading the disease on hospital wards, doctors have been told.
Instead relatives should be asked to use “mobile devices and video calling” to speak to dying patients rather than risk contracting the disease by visiting them in person.
The guidance seen by The Telegraph was issued to hospitals across the UK yesterday by the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists.
During the expected outbreak, clinicians should “restrict access to critical care areas for non-essential staff and any families or friends”, the document says.
When patients are believed to be dying, doctors should “discuss using mobile devices and video-calling with the local Caldicott Guardian, particularly on compassionate grounds during end-of-life processes”, it adds.
By law every NHS hospital must appoint a Caldicott Guardian, a senior clinician responsible for protecting the confidentiality of sensitive healthcare information.
Last night, senior doctors defended the new guidance and said it was necessary to protect both the relatives of the dying and the healthcare workers attempting to keep them alive.
“This might be distasteful to some, but in many cases it would be necessary,” said Dr Ron Daniels, founder of the UK Sepsis Trust and an intensive care consultant at the Heart of England NHS Foundation Trust.
“If, for example, you have the 90-year-old wife of an elderly man dying from coronavirus, you don’t want to bring her into that environment.
“That would be a risk to her, and potentially to the critical care staff on the ward.
“If, however, you’re talking about a healthy 30-year-old grandson, then I think most doctors would take the guidance with a pinch of salt and allow them to say goodbye in person.”
The guidance also outlines how NHS hospitals should allow junior staff to take on more advanced roles to prevent the system becoming overwhelmed.
Clinicians with “non-essential managerial roles” should be redeployed to the front line, it says, while “staff groups with critical care expertise may need to move to supervisory roles rather than bedside clinical care”.
“Any staff member can assist with moving equipment, restocking units, resupplying bed areas and completing administrative tasks,” it adds.
The document also advises in detail how newly-trained staff should ventilate coronavirus patients if they are struggling to breathe.
“Manual ventilation, or ‘hand-bagging’ is not advised,” it says.
Meanwhile hospital staff are told to “support each other” through the crisis, and not allow leaders to make critical decisions alone.
“Leadership in a crisis is stressful and demanding. The clinical director alone cannot do everything,” it says.
“Ensure strong support of physical and mental wellbeing, focusing on emotional support, nutrition, hydration and sleep.”
Simon Stevens, Chief Executive of the NHS, confirmed yesterday that the vast majority of visitors would be banned from hospitals in England in a bid to curb the spread of the coronavirus, although there would be exceptions in some cases.
The announcement came after doctors were warned last week that they may have to perform tasks for which they are not properly trained to cope with the “abnormal emergency” of coronavirus.
Prof Chris Whitty, the Chief Medical Officer for England, told medics that a flood of patients with Covid-19 could force them “to depart, possibly significantly, from established procedures in order to care for patients in the highly challenging but time-bound circumstances of the peak of an epidemic”.
In an open letter, which he shared in a tweet, Prof Whitty called on NHS staff to “stick to the basic principles of being a good doctor”, applying a “rational approach to varying practice in an emergency”.
The CMO also urged doctors not to allow the fear of disciplinary action to prevent Prof Whitty’s letter came after warnings that half of all the UK’s coronavirus cases could occur within just three weeks, potentially paralysing hospitals.