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February 9, 2017

Why more hospitals are inviting families into the ICU

Daily Briefing

Hospitals increasingly are trying to incorporate ICU patients' family members into health care decisions as hospitals look for ways to improve outcomes and cut costs—a trend that could gain traction following new guidance from the Society of Critical Care Medicine (SCCM) encouraging such "family-centered care," Meredith Cohn writes for the Baltimore Sun.

ICUs traditionally limit family access

Traditionally, ICUs limit families' access to patients. While many hospitals in the past have implemented some protocol for accommodating families, hospitals typically adopted such efforts "without spending much or upsetting the long-standing medical culture," Cohn writes.

Earlier ICU guidelines were not based on evidence of better outcomes or reduced costs, according to Giora Netzer, a critical care specialist at University of Maryland Medical Center (UM Medical Center) who helped develop SCCM's new ICU guidance. Moreover, Netzer pointed to research suggesting that patients fare better when their loved ones are more engaged.

According to Netzer, research shows that a focus on a patient's family can reduce the length of a hospital stay and help curb costs. And other research suggests that once patients leave the hospital, families are well positioned to provide care—which in turn could improve patients' quality of life and reduce readmissions, Cohn writes.

"It's not just more humane care, it ends up being better health care," Netzer said.

New guidance

Among the new guidelines, SCCM recommends that hospitals:

  • Give families easy access to patients in the ICU;
  • Include sleeping options for family members in the ICU;
  • Employ staff dedicated to helping families understand hospital procedures;
  • Provide patients' families with more consistent updates;
  • Ensure that spiritual and social support is available;
  • Include families in medical decision-making; and
  • Share recommendations about providing care for the patient after discharge.

According to Netzer, the new guidelines should speed up changes. "Some interventions cost money upfront, but in most cases things that improve family experiences may also conserve resources," she said.

ICUs move toward family-centered care

While there are still "a lot of gaps in the research," multiple hospitals have been taking steps to incorporate more family-centered care in the ICU, Cohn writes.

For instance, Netzer pointed to changes that UM Medical Center has made to its ICUs, including:

  • Larger rooms, designed to accommodate families, who may visit at any time;
  • Informational pamphlets, which detail the medical center's family-centered approach toward care; 
  • Social workers who act as "navigators," helping families communicate with physicians or find services such as pastoral care or alternative therapies; and
  • A pilot program assessing whether patients benefit when their family members are permitted to attend rounds.

Johns Hopkins Hospital also has implemented several changes to foster family-centered care, according to Rebecca Aslakson—an associate professor of anesthesiology and critical-care medicine at the Johns Hopkins University School of Medicine. Aslakson, who also helped develop the new SCCM guidelines, said the hospital has increased its communication with family members and reconfigured its ICU to accommodate reclining chairs so family members have a place to sleep.

Change anticipated, but challenges remain

While Aslakson expects hospitals to continue to evolve their ICU policies, many hospitals are not able to increase staff or make the physical changes necessary, Cohn writes. She adds that there could also be a "cultural resistance" at some hospitals to changes such as having family members attend rounds—meetings that traditionally have been "the exclusive domain" of clinicians. 

Renee Boss, a medical ethicist in Hopkins' Berman Institute of Bioethics, acknowledged that larger changes, such as allowing family members to attend rounds, might not be standardized until there is evidence that it helps. "Multiple studies of both patients and families show they have some form of post-traumatic stress disorder from being in the ICU, and the question is can we help alleviate and reduce that or make that go away by better attending to the family," Boss said. "There is promise. But we don't yet know enough to say whether there are important enough outcomes that we should require all ICUs to do this."

Still, Boss said she does not expect significant resistance to the notion of better accommodating families. She pointed out that neonatal ICUs have for years incorporated parents into their children's care.

Eileen Rubin—founder of the patient advocacy group ARDS Foundation, who provided input on the new SCCM guidelines—said, "It's been gradual, but I think there has been some change [toward family-centered care]. And we need that. Patients and families need to be included as part of the team" (Cohn, Baltimore Sun, 2/2).

5 myths physicians believe about patient experience

Excellent patient experience is a critical piece of modern medicine, reflected clearly in outcomes. And more than amenities, clean rooms, or quiet during night, the factors that most inflect patient experience all relate to communication and coordination among the care team—factors that physicians are in a unique position to influence.

Clinician-patient communication, leadership of the care team, and support and empathy for the patient across the unit are the most important factors for success, and they're all driven by the physician as the "Influencer in Chief."

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