Teamwork to develop patient aid

Medical professionals are collaborating with computer scientists on a project that aims to give back the power of communication to severely incapacitated patients in intensive care units.

Ian Ricketts, of Dundee University's department of applied computing, said:

"Patients in intensive care units often have tubes down their throats that prevent them from speaking. While there is a need for medical staff and visitors to communicate with these pati-ents, they have been temporarily robbed of their ability to reply in the normal way.

"Often patients can communicate only by a nod or shake of the head and that requires their communication partner to ask the right question in the first place. And while the patient's immediate needs may be communicated relatively simply, emotional communication is much more difficult. It is one thing to indicate that you want a drink, quite another to say, 'I still love you and don't blame you for what happened.'"

Professor Ricketts said many patients arrived in intensive carewithout any warning - for example, people who have been involved in traffic accidents - and were often not fully conscious, confused and in a state of shock.

A communication aid would have to be extremely simple to use, given that the patients would have had no previous experience with such a device and would find learning difficult in the high-stress environment of the intensive care unit.

"We are seeking to create a system that requires very little training - it must be intuitive in its use and be able to convey information relevant to the particular patient using it," Professor Ricketts said.

The first stage is to identify what patients communicate while in intensive care. An observer in an intensive care unit will monitor and record on a computer the communication between patients and medical staff and relatives. This information will be used to form a "core vocabulary" of phrases that all patients will use. It might include phrases such as "Could I have something for the pain?" or "Where am I?"

The system could be customised to individual circumstances. The team is devising a computerised questionnaire for acquaintances of patients to complete. This would include more personal information such as the names of family members.

The team has yet to decide on the most useful form of communication device to be used by patients.

"We are thinking in terms of a portable computer," Professor Ricketts said. "But we have to bear in mind that the patient is lying in bed, often extensively wired up, and is unlikely to be able to operate a keyboard. We need to think carefully about an appropriate interface for a patient in intensive care - a touch screen might be helpful.

"Ideally the system would require very little input from the patient to express what they want to say and would not require any training. That really is a challenge."

The researchers, at the University of Dundee and Ninewells Hospital, are hoping to have produced a prototype computer-based communications system within the next 18 months. The work is being funded by the Engineering and Physical Sciences Research Council.

Project details available at www.computing.dundee.ac.uk/acprojects/icutalk