Introduction: The ICU as a technology design setting requires specific and thoughtful awareness of patient-, caregiver-, and environment-related constraints. Designing an ICU-specific communication system involves an even deeper understanding of patient needs and desires, building on existing work exploring available technologies for use in this setting1,2. We report our initial experience from a pilot study with a novel communication device engineered specifically to allow mechanically ventilated ICU patients to communicate with caregivers3. Methods: We used a validated survey for nurses about communication purposes to explore relevant beliefs, attitudes, and desires of nurses4. Existing technologies available for communication assistance in the ICU – e.g., letter boards, writing on paper, and mouthing words – were analyzed. Suggestions about the content for an eventual communication system were collected. ICU-specific design requirements were noted, including adherence to infection control standards, accessibility to restrained patients, and availability to patients with motor weakness, contractures, edema, tremor, and/or neuropathy. In addition, the system must include a minimal learning curve, Results: Initial testing in the ICU has revealed additional considerations for technology design. For instance, many patients have visual impairments, so displays should be large and high-contrast. Furthermore, patients benefit from a very short teaching/demo process due to their short attention span. Additionally, leveraging interfaces with significant similarities to everyday systems appears to reduce confusion. Nurses also mentioned that the system should be accessible to at least some non-English-speaking patients. Finally, physical deficits that ICU patients experience require that manually operated devices be as flexible as possible in terms of type of manipulation required. Conclusions: ICU patients are in significant need of communication systems that meet their unique needs. Building such a system requires awareness of many different constraints, including both general heterogeneity of patient needs and capabilities and the constraints of the ICU setting itself.

Introduction: Available communication methods for intubated patients in the ICU are insufficient to meet patient needs. Both ICU patients and their care providers report broadly unsuccessful communication attempts, resulting in less effective medical care and undue stress1,2. Use of existing methods - including letter boards, writing, and mouthing words - for mechanically ventilated (MV) patients has led to a consensus that new methods are required3. We report on the testing of a new system designed to address the communication needs of MV patients that is currently being tested in a low- to medium- acuity surgical ICU4. Methods: We have developed several generations of prototypes designed to address patient communication needs. Design of this device has focused on ICU-specific communication needs, including ICU-specific content, infection control, simple design, and capitalizing on motor movements that can be easily performed by most ICU patients. Initial testing, starting with non-MV patients able to give more detailed feedback, has begun in a low- to medium- acuity surgical ICU. Recently developed prototypes combine custom-built tablet software, focusing on the needs that nurses believe patients wish to express in the ICU setting, with a newly designed manually operated access device. The system produces visual and auditory output to allow patients to answer basic questions and effectively convey information. Results: Initial patient impressions are encouraging, particularly among patients who have recently experienced mechanical ventilation. Many patients are unfamiliar with tablet software or struggle with manual dexterity required to access the tablet screen directly, further indicating the need for an external access method as part of the system. The content suggested by nurses via a previously conducted survey has been confirmed by patients as relevant to their experience. Conclusions: A novel manually operated communication system has elicited both positive reviews and helpful feedback from patients.