As with other forms of health care, there is increasing desire by patients and their loved ones to be more involved in what happens in hospital intensive care units (ICUs). But this desire can clash with pressures that are inherent in caring for patients whose health is so precarious, as well as ingrained routines that ICU staff often embrace. Yale clinicians, in a study published in Critical Care Medicine, collaborated with the Society of Critical Care Medicine (SCCM) to demonstrate potential routes for making intensive care more patient- and family-centered.
With financial support from the Patient-Centered Outcomes Research Institute (PCORI), the SCCM team enlisted 63 institutions in 34 U.S. states as a collaborative in an effort to demonstrate broader findings than prior attempts to analyze individual ICUs could uncover. Over a 10-month period, family-centered care champions at these facilities encouraged physicians and staff in both adult and pediatric ICUs to bring their daily procedures more in line with what surveys indicate families want—including a sense that loved ones in the ICU are not just visitors but an integral part of the patient’s care, that families should be included on caregivers’ rounds, and that families need to be involved in the health providers’ decision making. Desires also include the formation of patient and family advisory councils, and more written information provided to loved ones.
According to David Y. Hwang, MD, an associate professor in the Division of Neurocritical Care and Emergency Neurology at Yale and a key member of the authorship team, buy-in by ICU teams for such practice changes can be hard to achieve, fueled by difficulty managing the workload involved in implementing procedural change, a lack of staff awareness and interest, and limited funding. The SCCM collaborative found that physician and nurse “champions” within ICUs who are dedicated to change can help tremendously with maintaining the energy necessary to start up and maintain family-centered care initiatives. The collaborative was able to show that, despite the challenges it found, surveys showed that satisfaction with ICU care among families within participating ICUs was higher at the end of the 10-month period than at the start.
Hwang says that patient- and family-engagement is an essential and inevitable component of critical care, and he hopes that lessons learned through this study will help make promotion of family-centered care projects the norm in ICUs everywhere.