Award Honors Efforts to Connect with Patients and Families
Most patients seeking care at Beth Israel Medical Center are uninsured, are from the inner city, and depend on public transportation. Two years ago, most young critical care patients in this New York community needed to be transferred to other hospitals miles away, putting greater stress on families emotionally and financially.
In August 2004, a multiprofessional team of pediatric critical care professionals saw a chance to improve the quality and level of care for these young patients and their families. They renovated a closed section of the hospital and created a state-of-the-art pediatric intensive care unit (PICU) aimed at creating a better experience for those needing such care. The Beth Israel PICU team was recognized by the Society of Critical Care Medicine (SCCM) with this year’s Family-Centered Care Award. Edward Conway, MD, MS, FCCM, accepted the award on behalf of the team during the 36th Critical Care Congress. The Patient and Family Support Committee offers this award annually to an ICU team that has improved the care provided to critically ill and injured patients and their families, qualities that the Beth Israel team has displayed proudly.
What Would Make Your Stay Better?
The multiprofessional team’s goal was to ensure a continuing and open dialogue among patients, parents and staff, which ultimately would lead to increased patient satisfaction. This goal required new, creative approaches. One way to open these lines of communication, introduced by the hospital’s CEO and president David J. Shulkin, MD, was to hang dry-erase boards on the door of each PICU room. The boards provided the opportunity to list three things that would make the patient’s stay better, and members of the team engaged in conversation with patients and families to fill in the list. The boards also displayed the date and noted the staff caring for the patient.
“We have found that this simple, inexpensive technique provides us with a wealth of information and allows the patients and their parents to be involved with the design of the hospital stay. It also allows us to identify issues early and to address them,” Dr. Conway said. The most common issues listed on the board include concerns about pain, sleep disturbance, blood drawing and keeping parents informed. Patients also make simple requests that can do a lot to improve their general mood such as a different menu or video suggestions.
A Comfortable and Thoughtful Experience
The family-centered model of care incorporates medical, spiritual and psychological aspects of healing. An ongoing parent survey finds that most use these services and appreciate the added attention given to the family’s overall well-being.
The Beth Israel PICU team includes hospitalists, residents, nurses, social workers, physical therapists, clergy, child life therapists, music therapists, bereavement counselors and various support staff. The entire team collaborates daily during morning rounds to ensure complete and compassionate care for patients and families throughout their healthcare experience. Support is provided from diagnosis to hospital discharge and during outpatient follow- up.
Many resources are available to families to help them cope with stress. Coffee, bagels, and fruits are provided to parents each morning while the team completes patient rounds. This allows them nourishment and the opportunity to meet other parents in similar situations. A 24-hour visitation policy keeps parents and children together even at night. A sleeping area is provided at the bedside or in the cozy family lounge, which models a comfortable family room and includes two refrigerators, a computer, a facsimile machine, a phone, a television, reading materials for children and parents, and large couches that convert into beds. Spiritual support, provided by multidenominational pastoral care, is always available, and a pediatric social worker is on staff. A comprehensive child life department also provides a variety of services, including intensive art, play, music, and pet therapy.
Sharing Their Success
Evidence of patient and family satisfaction has been documented in Press Ganey surveys and in a child life, pain and modified PICU parent survey published by McPherson et al. in the August 2000 issue of Critical Care Medicine.1 The patient satisfaction scores for the last quarter of 2005 ranked at 100% for most nursing and physician indicators, placing the unit well above the national benchmark and at the top of its healthcare systems ratings. During many of the quality improvement and planning meetings, staff members discuss how to extend these results to other areas of the hospital and beyond. Dr. Conway encourages the team to lead with a common-sense approach. Attention to small details or adding an aspect of home and security to the PICU goes a long way in helping patients and families cope with the critical care experience.
