Family-centered approach improves communication and care in intensive care unit

A nationwide hospital program developed to support families visiting loved ones in the intensive care unit (ICU) has significant benefits for families, patients, and team members in the ICU, shows a new study.

As reported in a supplement to the September issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), implementation of the Critical Care Family Assistance Program (CCFAP) significantly increased family satisfaction with communication with ICU team members and care of their loved one; decreased family stress; decreased patient anxiety; and increased staff communication and collaboration across hospital departments.

"Research shows that families are not entirely satisfied with their treatment within an ICU while a family member is under care, which can cause unnecessary stress and anxiety for both the family and patient. Yet, it is clear that addressing family needs in the ICU contributes to families' overall satisfaction with ICU care," said coauthor of the study D. Robert McCaffree, MD, Master FCCP, President of The CHEST Foundation and Chief of Staff, Oklahoma Medical Center, VA Medical Center, Oklahoma City, OK. "The Critical Care Family Assistance Program is the first replicable nationwide ICU program structured with the needs of both the patient and family in mind."

Developed by The CHEST Foundation, the CCFAP aims to improve family satisfaction with ICU communication and care by utilizing a multidisciplinary team of professionals who are dedicated to fostering an ICU environment where families feel well informed, comfortable, and safe. CCFAP teams at Evanston Hospital, Evanston, IL, and the VA Medical Center, Oklahoma City, OK, collected satisfaction data from 537 families of loved ones in the ICU and hospital staff prior to, and after, the implementation of the CCFAP. Surveys measured family stress level, family need for specific services, family satisfaction with ICU team communication and care regarding their loved one, and family satisfaction with their own treatment and care by the ICU team. Staff surveys measured changes in staff perception of ICU climate, family satisfaction with care and communication, family stress levels, and program impact on their work environment.

Significant increases were seen in the areas of family satisfaction related to care and treatment of their loved one; family perception of safe hospital environment; improved comprehension of information provided to families; and decreased patient anxiety. The most profound impact was on the degree to which families felt they were involved in the decision-making process. In addition, results showed significant decreases in family members' stress/anxiety level when they received CCFAP information or services. In regard to staff, results showed that there were significant increases in staff identification and referrals of families in need of services; staff perception of positive change in family satisfaction of communication, care, and treatment; collaboration among ICU team members and hospital departments; and the ability of hospital to respond to family needs.

"The Critical Care Family Assistance Program has allowed us to increase the level of service we provide for our ICU patients and their families. As a result, we have had an overwhelming positive response from families, patients, and hospital team members," said Raymond Grady, President and CEO of Evanston Hospital. "The success of the CCFAP at Evanston has encouraged us to consider expanding the family assistance program to other areas of the hospital."

The CHEST Foundation, the philanthropic arm of the ACCP, provided funding for implementation of the CCFAP in eight sites across the country. Although specific amenities vary from site to site, hospitals that have implemented the CCFAP offer family members hospitality and support services, educational resources, and adapt technology and the ICU physical environment to make them more family-focused. The CCFAP can be implemented in any hospital with an ICU and varying models of care, including government-run institutions, community hospitals, community teaching hospitals, rural hospitals, inner city hospitals, urban hospitals, academic medical centers, and pediatric hospitals. Due to the overwhelming success of the program, The CHEST Foundation developed the CCFAP CD-ROM interactive toolkit so that many more institutions could have access to the program information, enabling them to replicate the program and implement the initiatives on their own.

"The ICU is often an intense and overwhelming place for patients and their families. By addressing the needs of both the patient and the family, hospitals can create a trusting and supportive environment where families are recognized as an integral part of patient care and recovery," said Paul A. Kvale, MD, FCCP, President of the American College of Chest Physicians.