Promoting Family Engagement in the ICU: Experience From a National Collaborative of 63 ICUs*

Abstract

Objectives: As part of an improvement program targeting ICU, a national collaborative was launched to help hospitals implement patient- and family-centered care engagement initiatives. Design: Ten-month quality improvement collaborative. Setting: Guided by a national patient and family advisory group, participating teams implemented an individual project including open visitation; integrating families on rounds; establishing a patient and family advisory committee; using patient and family diaries, among others. Subjects: Sixty-three adult and PICU teams from both academic and community hospitals in 34 states participated. Interventions: Monthly team calls, quarterly webinars, newsletters, an online eCommunity, and team reporting assignments were used to facilitate project implementation. Measurements and Main Results: The Family Satisfaction with Care in the ICU 24 was used to assess family satisfaction. Clinician perceptions were assessed with the Institute for Patient- and Family-Centered Care Self-Assessment Inventory. Thematic analysis was used to explore narrative data captured from team reports of project barriers, facilitators, and the experience of participating in the collaborative. A total of 2,530 family member and 3,999 clinician surveys were completed. Postimplementation, family members reported statistically significant increases in overall family satisfaction, satisfaction with decision-making, and satisfaction with quality of care (Family Satisfaction with Care in the ICU mean score change range 0.83–1.24; p ≤ 0.027). Clinicians reported that opportunities for families to participate as members of the care team increased. Major barriers included lack of buy-in and ability to promote change in the clinical setting, managing the workload of implementation, and funding to support initiatives. Conclusions: A national collaborative format was useful to assist ICU teams to implement patient- and family-engagement initiatives. Enlisting stakeholder support, engaging unit-based champions, and highlighting benefits of family engagement can help ICU teams to promote family member involvement and engagement.

Evaluating Pediatric Families’ Understanding of and Reactions to COVID-19 Visitor Restrictions

“…Hospital visitor restrictions pose challenges for healthcare providers, patients and their families, raising potential ethical dilemmas which require careful risk-benefit analyses (5) to balance public health needs with the known benefits of familycentered care for hospitalized patients and families (6)(7)(8). Due to their inherent dependence on surrogate decision makers for their psychosocial and physical wellbeing, pediatric patients are especially vulnerable to abrupt changes in visitation policies.…”

Asynchronous video messaging promotes family involvement and mitigates separation in neonatal care

“…There is growing appreciation of models of neonatal care designed to engage and empower families as primary caregivers. [1][2][3][4] These models of family integrated care (FiCare) are associated with improved outcomes for patients, their families and service providers. 5 6 Unrestricted family access is a key component of FiCare.…”

An environmental scan of visitation policies in Canadian intensive care units during the first wave of the COVID-19 pandemic

“… 3 , 4 Family members of critically ill patients may also experience significant and long-lasting psychological distress. 5 Family presence at the bedside can improve patient 6 – 11 and family outcomes, 8 , 9 , 12 – 15 increase communication and satisfaction, 16 and promote shared decision-making. 5 Nevertheless, this important source of support for critically ill patients was in jeopardy during the first wave of the COVID-19 pandemic, as widespread restrictions on family presence were implemented across healthcare settings to limit potential exposure to the virus.…”