Last December, Journal of Critical Care published the article Patient and family engagement in the ICU: report from the task force of the World Federation of Societies of Intensive and Critical Care Medicine, thanks to the leadership of Ruth Kleinpell.
Patient and family engagement in the ICU has demosntrated in a recent systematic review and meta-analisys an impact on ICU length of stay and improved family satisfaction, patient experience, medical goal achievement, and patient & family mental health outcomes. However, the majority of the studies in that review were based in the United States.
The objective was to conduct a cross-sectional survey to analyse practices on the involvement of patients and families in the different countries of the Federation.
A total of 345 responses were received from 40 countries. Varying practices with respect to patient and Heathcare delivery family engagement were reported. These practices where the following: daily conversations with relatives about progress, include families on rounds, Ethics consultations, family care conferences to discuss goals of care, Open/flexible visitation, family support specialist roles, use of social workers or psychologists, multidisciplinary rounds taking place in the patient room, involving family in care of the patient (such as oral care, bathing, range of motion, feeding), family informationbooklet/pamphlet, ICU diaries, personalizing patient’s room, family presence during invasive procedures or resuscitation and family satisfaction surveys.
In this study, less than 40% reported open visitation practices; just over a half, structured patient and family care conferences to review goals of care; some (16%), family-centered rounds. ICU diaries, almost 33%; music or pet therapy in a 55%, and the use of patient and family advisory group by 30%.
60% provided written materials on the ICU to family members. Practices such as family presence during resuscitation were reported to be fully (12%) or somewhat adopted (33%), with less reporting family presence during invasive procedures (20.5%).
A number of barriers to implementing patient and family centered care practices were identified by countries, both structural/architectural, cultural and staff resistance.
The article specifically cites Proyecto HU-CI as an example of a useful strategy to promote the participation of patients and families in the ICU. Because of the the low response rate in Spain and Latin American countries, the survey was translated and adapted to Spanish with our help, in order to explore this reality in Spanish-speaking community. This data will be published later, but we advance that the rate of responses already exceeds that of the United States: thank you all for participating!!
Despite the study has a number of important limitations, several conclusions can be drawn. The involvement of relatives and patients in the ICU is a growing and beneficial reality around the world, which improves the attention and experience of all actors involved. There is still a long way to walk everywhere, and it is wonderful to be among the actors in this challenge.