Providers Split on Family Presence During ICU Procedures

Sarah J. Beesley, MD, MS

There appears to be no consensus among health care providers on whether family members should be present during procedures in the ICU. In fact, 38% say they do invite family to be present, while 35% say they are somewhat or strongly unlikely to do so.

Among the clinicians who routinely invite family members to be present during ICU procedures, the practice is overwhelmingly supported—90% say it’s generally a positive experience.

The research, which was presented at the 2019 American Thoracic Society (ATS) International Conference in Dallas, TX, was conducted across 14 hospitals in an integrated health system in Utah.

Investigators at Intermountain Healthcare surveyed 125 critical care providers, including physicians, nurses, and advanced care practitioners, about their practices and attitudes around family presence in the ICU during procedures. Of the 84 (65%) of clinicians who responded to the survey, 50% were physicians, 36% nurses, and 14% advanced care practitioners.

“We found many critical care physicians are already allowing family into the ICU during procedures, which is great because it likely benefits almost everyone,” said lead author Sarah J. Beesley, MD, MS, clinical researcher at Intermountain Healthcare’s Center for Humanizing Critical Care. “But there are still concerns about this practice, which we have identified and want to address.”

The respondents who had reservations noted in their own words concerns about sterility, distraction, trainee education, or medicolegal concerns.

“The rooms are too small to maintain sterility and focus while trying to make room for family. It is extremely difficult when they are non-compliant with restrictions,” wrote one survey responder. “It is completely inappropriate to have family present for procedures.”

Another noted that family presence when a provider is learning how to perform a procedure can increase anxiety for both the trainee and the family members.

Physicians were the most likely to allow family members to remain in the room during ICU procedures—55% of physicians reported this practice compared to 29% for nurses and 17% for advanced care practitioners (P = .02). Allowing family presence during procedures was not associated with facility or shift.

Beesley said the next step is trying to better understand why certain providers are opposed to family presence during procedures and how to ease their concerns.

“Clinicians who do allow greater family access find it to be a safe and satisfying situation, and we want to work to understand the nearly 60% of clinicians who aren’t allowing it right now,” she said. “If there’s not a reason to exclude families, they should be invited to be a part of what their loved one is experiencing.”

The abstract, “Attitudes Surrounding Family Presence at Procedures Within a Single Health System,” was presented on May 20 at ATS 2019.