Guidelines promote more family engagement in intensive care units

Having a loved one go through a critical illness is a stressful and traumatic experience that may have lasting effects months after the patient is discharged from the intensive care unit (ICU). To improve the well-being of both patients and family during this vulnerable time, a set of new guidelines has been released, providing physicians with evidence-based strategies to optimize outcomes for the critically ill and those at their bedside.
“There is increasing awareness that support for family can also improve patient outcomes,” said Judy Davidson, lead author of the guidelines and a nurse at UC San Diego Health. “Families in the ICU aren’t visitors — they are an integral part of the care and the care team.”
Based on an analysis of more than 450 qualitative and quantitative studies, a multidisciplinary, international panel of 29 health care experts developed a series of recommendations for family-centred care, defined as an approach to healthcare that is respectful of and responsive to individual families’ needs and values. The experiences and perspectives of former ICU patients and family members from UC San Diego Health, the University of Maryland (UOM) School of Medicine, patient advocacy organizations and the LGBTQ community were used to develop the new guidelines.
The 23 recommendations grouped into five categories include: space for loved ones to sleep; educational programmes to teach family how to assist with care; encouraging family members to be part of the decision-making process; implementing ICU diaries to reduce a family’s anxiety and post-traumatic stress; and involving a multi-disciplinary team, such as psychologists, social workers and spiritual advisors. UC San Diego Health is among the first hospitals in the nation to embrace the concept of implementing a family diary in the ICUs.
“Structured interventions and approaches to support family members of critically ill patients are needed both to mitigate the impact of the crisis of critical illness and to prepare family members for decisionmaking and caregiving demands,” said Davidson. “Up to half of families with a critically ill loved one experience psychological symptoms. A robust programme built around family-centred care may decrease the negative impact surrounding critical illness. It is a matter of public health.”
The guidelines suggest that clinicians and institutions need to decide which intervention or combination of interventions are likely to be the most successful in specific circumstances.
“We have developed a self-analysis tool that ICUs can use to build a customized family-centered plan that will bring change,” said Robert El-Kareh, MD, MPH, hospitalist at UC San Diego Health and associate professor at UC San Diego of Medicine, who was instrumental in building translational tools to help ICUs move recommendations into practice.

University of California – San Diego