Annals of American Thoracic Society has just published in July a very interesting article on the presence of family members during Intensive Care Unit (ICU) procedures.

Its authors (physicians, nurses and members of the ICU Patient and Family Advisory Council at the Intermountain Medical Center in Utah, USA), present their experience of years trying to make the Intermountain Medical Center’s Shock Trauma (STICU) a more patient-centered and open space. A place where family members are not only welcomed, but are also part of the team looking after the patient.

The article discusses the benefits of allowing family members to be present during procedures (intubation, placement of central lines or paracentesis for example), including better communication with the healthcare team, improved patient and family satisfaction, decreased stress and anxiety, and reduced risk of suffering post-intensive care syndrome (PICS).

Physicians from other groups have raised concerns regarding the consequences of enabling families to be present during ICU procedures, particularly due to possible interference with trainee education, medicolegal implications, a decreased quality of care, and a raised stress in the provider due to feeling “observed”. 

However, these fears were not supported by evidence and did not reflect the experience of the STICU team.

Trainee education was not compromised, and neither family members nor physicians had problems with being in the same room during the procedure. The online supplement provides a script used by the senior author, Dr. Samuel Brown, to convey effectively to the patient, the family and the trainee physician what to expect during the procedure.

    * Litigation did not increase; on the contrary, the fact that family members were permitted to stay during the procedure improved communication and transparency, thus strengthening the trust of the family in the team.

    * The quality of care was not compromised, and clinicians did not report a higher level of stress due to being with the family member in the room.

    * Finally, sterility was not threatened, and although there is a higher “environmental microbial contamination” when family members are present, there has not been any infectious complications.

    After approximately 200-300 procedures with families in the room without negative experiences, the STICU team suggest that family procedural presence should be encouraged in other ICUs. Contrary to what many physicians fear, the presence of family members during the procedure promotes and facilities communication between the clinician and the relatives, and enables a better understanding of the patient’s situation by the family (among other benefits already discussed).

    The authors recommend four interventions in order to make the ICU a more humane and patient-centered place. These are:

    1) To educate clinicians about the fact that enabling family members to witness invasive procedures have benefits both on the relatives as well as on the patients.

    2) To invite family members to stay during the preparation of the procedure, should they wish to do so.

    3) To enable family members to remain in the room during the procedure, if both the clinician and the family member are comfortable with it.

    4) To “engage further”, that is: to include “debriefing of patient and families after procedures”.To conclude, it is still a fact that many adult ICUs have restricted visitations and almost always families have to leave the room during invasive procedures. However, this fascinating and innovative research proves that a change is needed in the way the ICU teams interact with family members in order to deliver a meaningful and patient-centered care.

    Barbara Salas
    Medical student, Newcastle University (UK)
    BA Theology, University of Oxford (UK)