Back row:
Michael Howell, MD, MPH, Director of Critical Care Quality; Julie Irish, PhD, Director, Office of Education Research; Lachlan Forrow, MD, Director of Ethics and Palliative Care; Barbara Sarnoff Lee, LICSW, Director of Social Work; Patricia Hall, Unit Coordinator; Robin Griggs, RN, Nurse Manager; Peter Clardy, MD, Associate MICU Director; Jean Campbell, RN, Nurse Manager; Stephanie Harriston-Diggs, Director of Volunteer Services; Jane Foley, RN, MA, Director of Operations

Front row:
Sabrina Cannistraro, MS, Critical Care Quality Project Manager; Maureen Bisognano, ICU Patient and Family Advisory Council Member; Sue Pomfred, ICU Patient and Family Advisory Council Member; John Pomfred, ICU Patient and Family Advisory Council Member; Sharon O'Donoghue, RN, Clinical Nurse Specialist; Kristin Russell, RN, Nurse Manager

*Team members not pictured include Pamela Browall, RN, Nurse Manager, Coronary Care Unit; Wendy McHugh, RN, MS, Coordinator, Person-Center Critical Care Project; Cindy Phelan, RN, MS, Senior Director, Cardiovascular Institute; Joe Previtera, RRT, Manager, Respiratory Therapy; Marjorie Serrano, RN, MS, Nurse Manager, Cardiac/Vascular Surgery ICU; Daniel Talmor, MD, MPH, Director, Surgical and Trauma ICUs

Honorable Mention
HOSPITAL DE CLINICAS CARACAS, FAMILY-ORIENTED SUPPORT UNIT
Caracas, Venezuela

In 1994, the ICU staff at the Hospital de Clinicas Caracas detected problems affecting their patients’ families and, after careful study, established the Family-Oriented Support Unit (FOSU), assembling a multidisciplinary team of critical care physicians and nurses, bioethicists, and clinical psychologists to accomplish the following:

• Psychological evaluation and implementation of a psychotherapy process for each family using procedures such as intervention during crisis, emotional support, end-of-life family support, patient crisis intervention, respect of ethical principles, communicational connection, and management of sensorial overload. Since the FOSU was created in 1996, a total of 7,915 patient’s families have received this support from the team.
• Meetings between members of the team and each family at the end of every clinical round. Psychologists on the team now keep permanent communication open between families and health professionals.
• Entire team discussion during clinical rounds about withholding and withdrawal treatments in end-of-life care. To improve this process, a worksheet guide was designed to assure the rights of the patient and their family were correctly followed. When the decision of withholding or withdrawing is made, the team increases communication between the team and family, relocates patients to quieter FOSU areas, and allows families to stay with patients while the team monitors pain and suffering. A representative from the patient and family’s religion is also called upon by the FOSU to provide support according to their religious and cultural beliefs.
• ICU nurse, physician, and resident training, specifically in how to deliver bad news and manage grief or anger. The FOSU’s psychologists are further dedicated to the team by monitoring all professionals, watching for burnout and high stress signs.
• Utilization of bioethicists to promote an ethical approach to considering patient and family’s rights in every aspect of their treatment
• Change from traditional restricted visiting time to a free visiting schedule, coordinated by the FOSU psychologist during the day and nurses at night
• An informational brochure describing ICU characteristics, giving recommendations for families, and summarizing rights, given to families as soon as their relatives are admitted

To evaluate the effectiveness of its new FOSU and multidisciplinary team, the hospital has done a variety of studies, including but not limited to “Family psychology support unit in the ICU,” “ICU staff burnout,” “Effectiveness of a guide worksheet during end of life care.” Many of their studies have been presented in meetings and some, published. They have also organized courses about clinical bioethics and communication skills for health professionals.

The Hospital de Clinicas Caracas is congratulated and commended for their initiative and success in improving their ICU.

Shown above: the Hospital de Clinicas Caracas Family-Oriented Support Unit Team from left to right*

Back Row:
Juan Pal Otero, MD, Critical Care Attending Physician; Susana Pereira, ICU Clinical Psychologist; Pablo Pérez d’Empaire, MD, Critical Care Attending Physician; Carme Virginia Mujica, ICU Clinical Pyschologist

Middle Row:
Elina Siviero, Critical Care Nurse; Lolibel Quintero, Critical Care Nurse; Ivis Ruiz, Critical Care Education Manager Nurse; Yelitza Descailles, Critical Care Nurse; Gabriel d’Empaire, MD, ICU Director

Front Row:
Dulce Hernandez, Critical Care Nurse; Ingrid Henriquez, Critical Care Nurse

*Team members not pictured include Maria Eugenia Fernández, MD, Master on Bioethics; Maria Isabel Parada, ICU Clinical Psychologist; Jenny Espinoza, ICU Clinical and Health Psychologist; Fernando Pérez Barreto, MD, Critical Care Attending Physician; Stevens Salva Sutherland, MD, Critical Care Attending Physician; Mercedes Delgado, Critical Care Nurse Manager