Hospital Wide Access to VR Alleviates Pain & Anxiety for Pediatric Patients
As patients at Lucile Packard Children’s Hospital Stanfordundergo routine medical procedures, they are being whisked away to swim under the sea, zap flying cheeseburgers in outer space, catch basketballs using their heads and fly on paper airplanes through the sky thanks to virtual reality (VR) technology, which is being implemented throughout the hospital to help ease patients’ feelings of pain and anxiety. Packard Children’s is one of the first hospitals in the country beginning to implement distraction-based VR therapy within every patient unit.
“Many kids associate the hospital with things they deem stressful and scary,” says pediatric anesthesiologist Sam Rodriguez, MD, co-founder of the CHARIOT program (short for Childhood Anxiety Reduction through Innovation and Technology), which is leading the VR rollout. “We are finding that the ability to distract these patients with fully immersive sensory environments can have a significant impact on the anxiety and pain they experience during minor procedures, dressing changes and other medical treatments.”
In February 2017, 9-year-old Blaine Baxter suffered a severe injury to his arm while racing a go-kart and had to undergo daily, painful dressing changes. “He would immediately start crying and scream out of fear, and had to be sedated before doctors could approach his arm,” explained Blaine’s mother, Tamara Baxter. “He was so riddled with anxiety after everything he had been through. VR was a game changer. As soon as Blaine put the goggles on, sedation was no longer needed and during his dressing changes we went from hearing pain-stricken screams to ‘Wow, I’m under the sea looking at sea snakes. This is so cool. You have to see this!'”
The hospital-wide VR rollout is the latest evolution in distraction therapy techniques pioneered by Rodriguez and fellow anesthesiologist Thomas Caruso, MD, who co-founded CHARIOT with Rodriguez. In 2015 the duo introduced Bedside Entertainment and Relaxation Theater (BERT), and earlier this year launched Sevo the Dragon, which takes a necessary part of anesthesia — breathing anesthesia medicine through a mask — and transforms it into an interactive video game projected on the BERT screen.
VR is currently being used in Packard Children’s Bass Center for Childhood Cancer and Blood Diseases, short stay unit, emergency department, vascular access, imaging, ambulatory orthopedics, general surgery clinics and perioperative unit for patients as young as 6-years-old. It will be rolled out to the hospital’s acute care floor units, Stanford Children’s Health’s ambulatory surgery and labor and delivery by the end of the year. In addition, pediatricians at the Stanford Children’s Health Bayside Medical Group — Berkeley clinic will be implementing VR technology during immunizations.
The CHARIOT team has medically customized the VR headsets with an easy-to-clean strap and a disposable liner for immunocompromised patients on contact precautions. Sound capabilities allow the volume to be adjusted so the care team can communicate with patients during procedures, and each headset is accompanied by a smartphone preloaded with customized content specific to children in the hospital. The CHARIOT team carefully selects games that require limited movement so kids seated in bed can play without turning their bodies or getting tangled in IV lines. CHARIOT also works with companies to adapt commercially available games for the health care setting, and are working with Silicon Valley–based software engineers to develop original VR content specifically created for the hospital setting. Their first game, Spaceburgers, allows health care providers to use a controller to increase the level of distraction during the most stressful parts of a procedure, like right before a needle poke.
Research is underway to quantify the impact VR has on the levels of pain and anxiety that patients experience during vascular access procedures by comparing the experiences of patients who have used VR with those who have not. “Preliminary results have shown that kids tend to be more cooperative when they are engaged in VR, with less movement, less fear and sometimes even lower pain scores,” Rodriguez explains.
Additionally, the CHARIOT team is researching the impact of passive games (e.g., watching fish float by) compared with active games (e.g., zapping “spaceburgers”) to understand whether the content itself affects patients’ reported pain and anxiety levels. Packard Children’s is one of the first hospitals to integrate the use of VR as a potential method of anxiety reduction into patients’ electronic medical records (EMRs), which is helping care teams determine which content is most effective for certain populations, according to patient age, procedure and content type.
CHARIOT’s hospital-wide VR rollout is on track to be fully realized in the new Lucile Packard Children’s Hospital Stanford, which is set to open in December 2017.
New content and more VR headsets will be available, including additional headsets specifically for patients with chronic conditions who are using VR as a relaxation technique to escape the hospital environment. For patients who are interested in watching their IV placements and minor procedures as they happen, CHARIOT has recently introduced augmented reality (AR) headsets — a technology that layers visual enhancements atop existing reality.
In addition, Rodriguez and Caruso are in discussions with local tech companies about how to share these technologies beyond Packard Children’s. “Our overarching mission is to help as many children as we can and make our discoveries available to other people and other hospitals,” Caruso says.
Rodriguez hopes that the program will continue to improve patients’ experiences as it evolves. “If you can take someone and alleviate their fear, it makes everything we’re doing worthwhile.”