The Hospital and ICU Environment The family perspective environment... · The family perspective...

The Hospital and ICU Environment

The family perspective

Sangeeta Mehta MD

@geetamehta0

Sinai Health System & University of Toronto

CCCF November 11, 2019

Disclosures

• I have nothing to disclose

• Within the last 12 months I have not had any type of

financial arrangement or affiliation with commercial

interests related to the content of this continuing education

activity that requires disclosure

Background

• Family members of critically ill patients spend prolonged durations of time in the hospital, waiting room and ICU

• Flexible 24/7 visitation more common

• Their practical and material needs within the hospital and waiting room are not known

• They can provide insight on improving patient comfort in the ICU

Crit Care Med 2002

- 9 ICUS at tertiary hospital- 449 family members- Family Satisfaction with Care in the ICU instrument

Objectives

• What are the perspectives of visitors to the ICU regarding the physical environment of the hospital, waiting room, and patient ICU rooms?

• What do they value for themselves and for patients?

Methods

• Formal survey development: Literature search, item generation, questionnaire development and testing

• Inter-professional collaboration, patients, and visitors (family members and friends)

• 4 University affiliated ICUs: Sinai Health, St Michael’s, Niagara Health, Juravinski

• Visitors approached in waiting rooms and provided with anonymous questionnaire

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Hospital environment

Signage

Parking

Info on food & accommodation

Food preparation facilities

Sleeping in the hospital

Shower facilities

Religious/spiritual needs

Childcare

Interpreters

Waiting room

Furniture, art, paint, plants

Private space

Natural light/air

Informational material

Lockers

Visitor bathroom

Visitation

Television, computer, wifi

Reading material

Patient ICU room

Sleeping facility for family

Chair

Communication tool

Pet

Privacy

Natural light/air

TV/music/computer

Dimming of lights

9

Demographics

• 163 questionnaires completed

• 40% M, 59% F

• Person of colour / visible minority 20%

• First language: English 78%

Indian (9), European (7), French (3), Mandarin/Cantonese (4), Tagalog (2), Farsi (2), Persian (2), Amharic (2)

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Patient Age

20-40

41-60

61-80

81-90+

Visitor's Age

<20

20-40

41-60

61-80

81-90+

12

Relationship to Patient

Spouse/Partner

Child

Sibling

Parent

Friend

Other

Distance from Hospital

<30km

31-50km

51-100km

>100km

Distance from Hospital

<30km

31-50km

51-100km

>100km

Have you slept in the waiting room?

YESN=46 28%

NON=11672%

# nights: 1 2 3 4

N 17 14 6 3

Range: 1-7

nights

15

Extremely important

Very important82% 79% 79% 77%

56%50%

45%

61%

41%

Lower priority – Hospital environment

• Childcare

• Information about religious services

17

93%

80% 78%

71%65%

53%50%

85% 83%

Extremely important

Very important

Lower priority – ICU waiting room

• Religious symbols

• Paint colour / Art

• Plants and greenery

• Telephone

• Food-free waiting room

• Technology-free zone

Extremely important

Very important

93%

59% 57%62%63%

75% 76%73% 71%

Lower priority – Patient room

• Religious symbols

• Sleeping in the same bed

• Pet visitation

• Paint colour and Art

• TV / ipad / music

Textual comments

• More volunteers, and instruction

• Showers, sleeping facilities, more washrooms

• Regular cleaning of visitors’ facilities

• Phone charging stations / more outlets

• Sink in waiting room

• Privacy for nursing

• Eating area

• Surveyed visitors living > 1 hour drive from trauma center

• Daily median travel time >3 hours; daily cost $40/day

• Issues needing improvement

• Parking, Accommodation nearby

• Being introduced to unit/ward when they first come, Getting info from HCP

• Waiting room

• Important findings

• Some visitors slept in their cars

• Loved one’s illness affected their ability to work; loss of income

• Arrangements for care of dependent children, elderly, pets

• General Sleep Disturbance Scale (GSDS), Beck Anxiety Inventory (BAI), Lee’s Numerical Rating System for Fatigue (NRS-F)

• Family members slept…

home (57% nights) waiting room (22% nights) hotel (18% nights)

• Why did they sleep in hospital?- home too far from hospital (30%)

- too anxious to leave hospital (19%)

• 27% (N=25) spent ≥ 1 night sleeping in hospital• significantly higher GSDS, BAI and NRS-F scores than visitors who never overnighted

J Pediatric Psychology 2008

Telephone survey

135 Canadian / US pediatric hospitals

J for Healthcare Quality 2013

Pleasant

Privacy

NoiseLightsStimulation

Olausson, Intensive and Crit Care Nursing 2012

29

30

Critical Care Patient Journey Map

31

What do visitors to ICU prioritize…

For patients

•Chairs

•Natural light, fresh air

•Dim lighting at night

•White board

•Privacy

For themselves

•Open visitation

•Signage

•Parking

•Shower

•To sleep nearby or in the pt room

•Water

•Comfortable furniture

•Wifi/charging station

With thanks to…

Sinai HealthSumesh Shah

Fernando Martinez Guasch

Nanki Ahluwalia

Uroosa Khan

Jocelyn Lau

Juravinski HospitalBram Rochwerg

Tina Millen

Alexa Bersenas

Niagara HealthJennifer Tsang

Mercedes Camargo Penuela

St Michael’s HospitalKaren Burns

Sandi Gobin

An ICU is a place to live - not just survive.

Woodward JA. RN 1978;41:62

Geeta.mehta@utoronto.ca

@geetamehta0

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35

J of Pediatric Psychology 2008;33:292-297

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Family needsPractical needs generally concern the family member’s feeling of comfort, in which both material and non-material matters can play a role.

In the category of the non-material needs, flexible visiting hours are at the top, followed by help with financial or family problems and explanations of what family members can do at the bedside of the patient and how they can contribute to the patient’s care.

Material things include a waiting room with a telephone, comfortable furniture, blankets and a place to lie down, a cafeteria and a toilet and a bathroom near the ICU. The priorities assigned to these material comfort needs vary.

That family members find their own material needs least important shows, once again, that they give absolute priority to everything that concerns the patient.

Hospitals give low priority to meeting the practical needs of family members who, in turn, express the least amount of satisfaction with it

What are the needs of visitors?

•Open visiting policy

•Comfortable waiting room close to ICU, with telephone and internet

•Signage

•Overnight accommodations

•Bathroom, shower

•Food