Sunnybrook VR tech reduces pre-op patient anxiety

By Rosie Lombardi

Dr Fahad AlamFuturistic virtual reality (VR) technology is already being tested for down-to-earth healthcare applications. Sunnybrook and Sick Kids hospitals in Toronto are collaborating in pilot projects that use VR to create an immersive experience that emulates what pre-operative patients can expect in the operating room in an effort to reduce anxiety and cortisol levels without medication. About 300 patients are participating in the two studies, says Dr. Fahad Alam (pictured), anesthesiologist and project leader of Sunnybrook’s VR lab.

Pre-operative anxiety levels matter because they are linked to many negative outcomes, including prolonged hospital stays, increased risk of infections, and increases in mortality in cardiac patients, says Alam. Patients are typically given sedatives and other medications the morning of their procedures to reduce anxiety, but this doesn’t reduce the stress-related cortisol levels that have built up for weeks.

“With VR, patients watch immersive videos two weeks prior to their surgery before as exposure therapy, so their stress levels won’t be as high by the time they come in for their surgery. This will hopefully reduce or eliminate the need for sedatives and other medications.”

Alam and his co-investigator Dr. Clyde Matava at SickKids Hospital set up the Collaborative Human Immersive and Interactive Lab (CHISIL) at the University of Toronto two years ago to create VR content for healthcare.

“One of the first things we did was create these pre-op anxiety videos because studies show patients are incredibly anxious before surgery. We film the experience of coming into a surgery, being wheeled through the OR on a gurney, meeting your nurse and anesthesiologist. You go into the OR and get the monitors put on.”

Two pilot projects are currently running in parallel at Sunnybrook and SickKids to test VR on 150 adults and 150 children, and are expected to be completed and assessed within two months.

“With children, we’re running more of a feasibility study to see whether kids will take to the technology. Will they be able to put these headsets on, and at what age will the content keep their attention? And we also want to get precise metrics about their anxiety levels before surgery.”

VR doesn’t require expensive technology anymore. The CHISIL lab’s equipment is readily available, and was initially acquired via a small funding grant from the Sunnybrook simulation centre, says Alam. “We used a GoPro 360 five-camera rig or similar equipment, and we used the software that comes with it to stitch those five videos together into 360-degree view. To view our immersive content, we use Google Cardboard at the hospitals and Samsung headsets at our lab.”

Beyond the hospital studies, the lab is involved in creating a variety of immersive content for different purposes. “Our three main areas are patient engagement, learner education and clinical management. Right now, we’re working on creating simulated crisis scenarios for our learners that transports them to a trauma bay where they manage the scenario, or to a hospital bed to attend to a patient in intensive critical care.”

The lab is a first in Canada. “We are the only hospital that has started an official lab in Canada when it comes to immersive education like this,” says Alam.

VR labs are popping up across North America in many forward-looking hospitals to create interactive content. “Their main areas right now are patient engagement as well as to help medical students learn anatomy and histology. We are taking it beyond this.”

These are still early days for VR in healthcare, and people are experimenting and trying to find its best uses and rightful niche, says Alam.

“It’s already a huge industry outside of healthcare. But VR technology is just a toy unless you create well- thought out content based on sound learning theories. With e-learning, we ran into problems years ago because content was just thrown online without any regard to its effectiveness online. We don’t want to make the same mistakes again. If anyone wants to create for VR, I think the most important thing for us, as educational leaders, is to make that we can actually enhance learning and engagement.”

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