Patient Satisfaction Planner
Program improves care, hospital collaborations
Surveys measured family stress level
A nationwide hospital program developed to support families visiting loved ones in the intensive care unit (ICU) has shown significant benefits for families, patients, and team members in the ICU, according to 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.
CCFAP teams at Evanston (IL) Hospital, and the VA Medical Center, in 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:
- family satisfaction related to care and treatment of their loved one;
- family perception of a safe hospital environment;
- improved comprehension of information provided to families;
- 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 levels 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 hospitals 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," says 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."
Literature shows a need
The idea for the program arose after literature was published in 2000-2001 indicating there were gaps in the attention being paid to family needs, recalls Robert McCaffree, MD, Master FCCP, president of The CHEST Foundation and chief of staff at VA Medical Center Oklahoma City, OK. "At that time, there was some discussion with the Eli Lilly foundation by the people of CHEST, and Lilly agreed to support this effort," he says. "We started discussions, and agreed on some of the fundamental parts of the program and on the two pilot sites."
The program was developed in concert by the CHEST foundation and the individuals involved in the pilot sites, says McCaffree. "Among those [basic elements] were a computer kiosk with information for families," he notes. Each facility had a different approach, he said. "Evanston purchased a commercial system, while we developed our own," McCaffree explains.
Another key element was a concierge service. "We wanted to find [family members] places to sleep, transportation to and from the hospital, and places to eat when the hospital café was closed," says McCaffree. "Both hospitals set up voucher systems for hotels, taxies, meals. We were then left pretty much to our own resources to design the other parts of the program."
At the VA medical center, for example, a sleep room’ was developed for family members. Both hospitals renovated their waiting rooms to make them more comfortable, and each developed a care package’ with toiletry items and so forth. "Evanston also developed a music therapy program and massage therapy program, while we are developing a pet therapy program," McCaffree adds.
Program spreads
After the initial pilot programs were evaluated, it was determined that different types of hospitals should be involved in early data gathering on the program, to see if it worked in a variety of facilities. "We now have eight — including a community/county indigent care hospital in Houston, a university hospital in Mobile, AL, a pure community hospital in Watertown, CT, and a pediatric hospital in California," McCaffree reports. "It’s a real variety, and they each have brought on two or three more."
While each facility is different, there are some common elements that are key to success, says McCaffree. For example, they involve interdisciplinary teams. "Clearly, you need one person to coordinate the program — it might be a social worker as it at ours, or a nurse, as it is at others," he explains. "Then, you should include as many areas as might be involved in patient care with the ICU — physicians, nursing, respiratory therapy, chaplains, dietitians, volunteer services. Quality managers certainly can be involved."
It’s critical, he adds, that the person running the program has the time to do so. "While we started the position as an additional duty of the social worker, we find it’s really becoming a full-time job," he says.
McCaffree says the CCFAP can be implemented in any hospital, although a certain base budget has to be taken into consideration. "For us, it is somewhere in the range of $30,000 to $50,000," he says. "That covers beepers, hotel vouchers, taxi vouchers, meal vouchers, and the care package. Then, there’s staffing."
McCaffree says this is a valuable investment. "It has really improved communication," he notes. "One hypothetical we have not yet proven is, if a critically ill patient feels his family is being taken care of, it takes that worry off of them and they can put more energy into the healing process, which will also save money for the hospital. The people involved with the program feel this is true."
Hospitals interested in the program can obtain, for a nominal feel, a "replication packet," created by facilities participating in CCFAP. It includes suggestions, experiences, strengths, and weaknesses. "Any hospital can take this and do it in their hospital," says McCaffree.
A nationwide hospital program developed to support families visiting loved ones in the intensive care unit (ICU) has shown significant benefits for families, patients, and team members in the ICU, according to a new study.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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