Developing a VR environment with the GOS hospital Clinical Simulation Team to help reduce procedural anxiety in young patients

Many patients are anxious when attending hospital for a procedure under general anesthetic (GA); sometimes requiring anxiety medication. Hospital tours during covid were not possible, requiring the team explore other methods of reducing patient anxiety. Using VR, we would provide virtual experiences of an Anesthetic room to show patients before attending. This would also provide the opportunity to reduce waiting times and hospital costs.

The Clinical Simulation Team (CST) at Great Ormond Street Hospital (GOSH) provide immersive environments that simulate clinical scenarios for medical staff training. These rooms offer the safety to practice skills needed when caring for sick children.

The CST team reached out to me in 2020 as they were looking to explore Virtual Reality (VR) simulation, alongside their current 360° video experience of the Anesthetic room. The team consisted of Myself, 2 CST members (1 Fellow and 1 Educator) and one UCL Medical Student.

_{Final VR Anaesthetic scene}

The project originally consisted of 2 levels: a 3D environment and 360° video experience. Once the 3D room doors open, they then lead to 360° experience. However, it was clear from user testing, that patients valued a VR experience that provided more support.

Due to limited hospital budget, we defined a manageable scope

Our idea was to start with a small part of the hospital where we believed VR would be effective. From the CST teams experience of looking after patients, coming for a procedure can be particularly worrying, especially those who need General Anaesthetic.

We reached out to the Young Peoples Forum (YPF) to gain ideas and insight into how we can use VR at GOSH. The YFP, made up of current and former patients & patient siblings of GOSH aged 10-18, meet to discuss ways to improve patient experience.

In November 2020, we presented to the YPF, addressing 2 important questions:

• What makes you feel anxious & safe?
• What should the virtual hospital be like?

3 breakout rooms were formed with different age groups: 10-14 (yellow), 15-16 (orange) and 17-18 (blue). We wanted to capture a wide array of opinions and information from the different ages.

Breakout room jam-boards had overwhelming feedback from the participants.

_{YPF jamboard feedback addressing our questions}

We also put forward the ideas of what the Anaesthetic room should look like. We made sure not to lead them in a particular direction.

_{Feedback on what anaesthetic room should be like}

We found that there were differing needs for both younger and older cohorts

Where young patients want family and distractions to feel safe, older patients wanted more clarity on procedure through a realistic environemnt.

Also, where the younger patients wanted games/quests in the VR environments, older patients wanted options to explore and interact with clinical staff.

To start modelling in 3D, I had to get ‘hands on’ with the room itself

To do this, I took reference photos of the GOS anaesthetic room. I was also informed by the CST Educator of important equipment used with patients in the room.

_{Reference images from GOS Anaesthetic room}

I started modelling the room in 3D, making sure important equipment was easily identifiable. Basic Maya shaders were applied to the meshes, making them resemble the room/equipment from the images. As the project would be viewed in VR through a mobile, I made sure that the models were not made up of too many polygons, whilst still maintaining resemblance to the actual equipment. The team were pleased with the design of the anesthetic room after presenting it to them.

_{3D Anaesthetic modelled in Maya}

Moving into VR

The environment was setup in Unity with some basic lighting.
A Reflection probe was added to generate reflections on meshes such as glass/mirror/monitors, offering more accurate lighting.
I built the VR application onto my mobile phone along with the Google Cardboard.

_{Unity scene}

_{Project in VR Google Cardboard}

Feedback from the YPF suggested that

We reached out to the YPF again to gain feedback on our project through more breakout rooms discussions, jamboards and a survey. Screenshots of the work were shown in the presentation, as well as a link to a hosting site that showcased my Unity project here. This allowed the patients to look around the 3D environment. The 360° video recording was also played.

_{Feedback from YPF meeting}

Results showed that the majority of patients thought the 3D room could help reduce their anxiety ahead of admission. Compared to a sizable 15% who thought the original 360° video experience ‘probably wouldn’t’.
When also asked what aspects of the experience they would want to interact with the most, the majority chose the ‘Anesthetic Machine‘ and ‘People looking after you‘. So it was clear to us that patients valued clarity and support.

We were given the opportunity to present at major conferenceses

The CST team put together 2 Conference posters which were accepted at the Royal College of Paediatrics and Child Health (RCPCH). These outlined the involvement with the YPF and our VR projects, as well as looking at forms of patient engagement via video conferencing and jamboards.

_{Abstract posters submissions for RCPCH}

Our project were also mentioned in a short journal written by the CYP Fellow:

_{Journal with our project mentioned}

The final result was highly promising

The final design presents the anesthetic room with all of its features and pieces of equipment. The scene is very immersive and provides the opportunity and space of patients to learn at ease. We had planned on implementing voice overs, annotations to flesh out the experience. However, talks broke down.

There were discussions about trialing the work, between GOSH Data Research, Innovation and Virtual Environments (DRIVE) unit and the Royal Free Hospital Innovation Team. Unfortunately later down the line, Royal Free had changed course, and we decided to part ways.
Also – due to the current CST Fellow leaving her placement – there was less engagement with the team and not much progress could be made, so talks ceased.

_{3D Anaesthetic room in Unity}

_{360 VR experience recording}

What I learned

Always take up opportunities to work with engaged teams
There is ongoing engagement and interest from Clinical Simulation departments to explore immersive projects within innovation. Whether for staff training or patient experience, the biggest interest comes from their department. And so being able to discuss and advise them on using VR for patient experience was a great opportunity.

Work with your users directly to foster stronger relationships
The YPF was also a key process in the project. At the end of the day, they will be the ones using the service, and so it’s standard knowledge that for a project to succeed, users need to remain at the heart of it.