The Society of Critical Care Medicine (SCCM) launched the Patient-Centered Outcomes Research – Intensive Care Unit (PCOR-ICU) Collaborative in 2016 to engage and partner with patients and families in ICUs across the United States. A total of 63 ICU units participated in the10-month collaborative to enhance communications and improve the critical care experience.
The Collaborative, supported by the the Patient-Centered Outcomes Research Institute and conducted by SCCM Quality and Safety Team, enabled participating hospitals to focus on a variety of tested and proven initiatives, but despite their differences, the goal of each initiative was the same—to involve patients and their family members as partners in the ICU care process.
“Patients and families know themselves and their loved ones best,” said SCCM President Jerry J. Zimmerman, MD, PhD, FCCM. “PCOR-ICU initiatives engage and empower the patient and family in the care plan.”
Here are three examples of successful patient-and-family centered innovations implemented by three units for the PCOR-ICU collaborative.
PATIENT AND FAMILY ADVISORY COUNCIL
The Yale New Haven Hospital (YNHH) already had several patient and family councils in place when the decision was made to launch one in the neuro-ICU in autumn 2017.
The goal of the neuro-ICU Patient Family Advisory Council (PFAC) was straightforward: YNHH wanted to hear directly from patients and their families about their ICU experiences as a way to improve and enhance all aspects of care in the ICU. Additionally, YNHH wanted to develop a stronger connection between patients and their families and caregivers.
The neuro-ICU PFAC “allows for greater collaboration with our caregivers and staff in a respectful and trusting environment,” said David Y. Hwang, MD, FAAN, FCCM, FNCS. “We use the Council to obtain feedback, develop new tools, communication scripts, surveys, and new innovations to enhance the experience for neuro-ICU patients and families.”
Council meetings are held every other month. Discussion topics range from a decision-making model for ICU patients’ family members to a letter with pertinent information for families transitioning from the neuro-ICU to the neurology step-down unit.
The PFAC evaluates work and initiatives produced by the Council as a measurement of success. Leadership also monitors feedback from Council members—both positive and negative. As initiatives are launched, feedback is also tracked. For example, families who received a transition letter showed a significant increase in patient and family satisfaction because their expectations were managed.
“All of the patient and family members selected and participating in the Patient-Family Advisory Council view themselves as a voice to help others from their own experiences,” Dr. Hwang said. “They feel like they are making a meaningful impact, and they can see their work come to fruition, which encourages them to keep going.”
The Children’s Hospital of Alabama wanted a way to enhance communication between family members and providers. In summer 2017, an ICU diary was introduced for the pediatric ICU. Hospital staff looked at multiple examples of diaries and decided that they wanted a hybrid diary that would feature a combination of free- writing areas and questions to prompt reflection. The goal of the project was simple—open communication.
“Open communication with families helps to ensure we are able to take the best care possible of their loved ones,” said William Sasser, MD. “Family members often provide valuable insight that helps tailor both communication and medical care.”
The hospital offered surveys to family members to evaluate their experiences with the diaries. It became clear that some family members found a lot of value in them. Others did not. As Dr. Sasser explained, though, that is okay. “I ultimately think it is a valuable tool to offer patients and parents,” he said, “but based on individual preference and processing style, it may not be a tool that is universally valued.”
Before joining the PCOR-ICU Collaborative, the St. Charles Medical Center in Bend, Oregon, USA, had a policy in place for ICU visitors. The policy was roughly 10 years old and was originally developed because staff members felt they could not care for patients with family members constantly spending time on site.
Ten years later that mindset has changed. Being a part of the PCOR-ICU Collaborative helped the St. Charles Medical Center team implement new policies while learning from other institutions about their successes and failures. The St. Charles Medical Center team reevaluated the visitation policy and decided to implement a new “open” visitation policy. Unfortunately, the policy did not work. Open was interpreted differently by various staff members, patients, and families. “It resulted in some unnecessary chaos,” shared Deanna M. Collins, MSN, RN, CCRN.
The center reevaluated the policy and put some slight limitations on it. For example, visitor entry was limited twice during the day due to shift changes, and the number of visitors at any one time was limited because of the center’s configuration. Perhaps the biggest change, though, was the name of the center’s policy. Rather than “Open Visitation,” St. Charles Medical Center now featured a “Flexible Visitation” policy.
“With the correct verbiage and instruction, families respect the idea of flexible and feel a part of our team in the care of their loved one,” Ms. Collins said. “The whole concept is trying to support and answer patient and family questions before they are asked,” Collins said. “We want families to be comfortable with the care their loved one is receiving and still take care of themselves as necessary.”