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Hospital Administrator’s Perspective*: The Critical Care Family Assistance Program FREE TO VIEW

Steven J. Gentling, MSHA; Raymond Grady, MSHA; Kenneth L. Mattox, MD, FCCP
Author and Funding Information

*From the Oklahoma City Veterans Affairs Medical Center (Mr. Gentling), Oklahoma City, OK; Evanston Northwestern Healthcare (Mr. Grady), Evanston, IL; and Ben Taub General Hospital (Dr. Mattox), Houston, TX.

Correspondence to: Kenneth L. Mattox, MD, FCCP, Ben Taub General Hospital, 1504 Taub Loop, Houston, TX 77030; e-mail: plisa@aol.com

Chest. 2005;128(3_suppl):103S-105S. doi:10.1378/chest.128.3_suppl.103S
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From the moment a patient enters one of our hospitals, that individual is entitled to our full attention and the best possible care we can provide. Our physicians, nurses, therapists, and the entire staff are focused either on delivering or supporting the health-care services required by the patient. We have always made that public commitment, and we never deviate from it. However, the Critical Care Family Assistance Program (CCFAP), which is located in each of our hospitals, has enabled us to broaden our focus to include a group that has not always been at the center of our attention, the families of those hospitalized in our ICUs. With the support of The CHEST Foundation and the Eli Lilly and Company Foundation, we have been able to introduce a program that tends to the needs of these family members as they go through a period of both painful uncertainty and mind-numbing anxiety. The efforts made to turn a more human face toward family members have, in a relatively short period of time produced significant results.

In 2002, the CCFAP was piloted in the following two hospitals: Evanston Northwestern Healthcare, Evanston, IL; and Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK. In 2003, the program was expanded at Evanston Northwestern Hospital to include a second hospital in Highland Park, IL, and Ben Taub General Hospital in Houston, TX, received funding to replicate the CCFAP. During the spring and summer of 2004, the program was funded for replication at Pardee Hospital in Hendersonville, NC, and at the University of South Alabama Medical Center in Mobile, AL.

The coordinated family care model provided by the CCFAP enables hospitals to make a consistent and constructive impact in improving communication and care for critically ill patients and their families. The CCFAP aims at responding to the needs of the families of critically ill patients by coordinating the provision of educational and family support services, by modifying and enhancing the physical environment of the ICU, and by implementing a communication model to improve the communication between the health-care team, and patients and their families. From an administrative perspective, the framework provided through the CCFAP enhances the capacity of the hospital to coordinate its response to family needs, as well as to respond to long-term needs associated with critical care environments.

First, the program provides a new model of coordinated care using multispecialty staffing. The CCFAP aims at providing a partial solution to potential staffing problems. If forecasts by medical specialty associations are accurate, shortages of critical care team members are quite likely in the next decade. Given this projected decline in workforce availability, the CCFAP can be an important component in devising an appropriate solution by fostering the formalization and coordination of professional staff services and by lessening the burden on the nursing staff.

Second, the financial exigencies of present-day health care demand that all new developments prove themselves in the marketplace. The CCFAP aims at producing worthwhile and long-term benefits in a demonstrably cost-effective manner. The research component of the CCFAP is systematically collecting data from each hospital on a wide variety of measures, calculated to examine the impact of the program on the entire hospital and associated costs. Current longitudinal studies are closely examining various factors, such as length of stay, staff training and retention, avoidance of legal action based on patient satisfaction, the coordination of care through a multispecialty team, and improved family satisfaction. The preliminary results of multiple regression and assumption tests (J. Dowling, PhD; unpublished data; December 2004) have indicated that the following are all significant positive predictors for overall satisfaction with experience at the hospital: provision of information and education; help with understanding the information received; sensitivity and responsiveness of the staff; a safe and secure environment; length of stay; physician concern over questions and worries; and physician friendliness and courtesy.

Third, the introduction of any new program is always greatly enhanced by its ability to sustain itself. The initial start-up and renovation costs of the CCFAP over the first 3 years were funded by The CHEST Foundation, with an increasing annual match by each hospital. While each hospital provides services and designates the appropriate space for the necessary waiting areas and conference rooms, the basic structure of the CCFAP is established during the funding period. The goals of the CCFAP are adopted by staff, the necessary physical modifications of space are completed, important linkage is established between the ICU and other departments, and research assists the unit to determine what aspects of the program are most successful in achieving the goal of increasing satisfaction by the families of ICU patients. At the end of this 3-year period, the expectation is that the position of CCFAP project coordinator has been firmly established and the CCFAP has been absorbed irreversibly into the organizational structure of the hospital. Undoubtedly, that will mean something different for each hospital; however, there is such broad support for the program that building on what currently exists should ensure its long-term presence. There is confidence in doing so since each hospital will be able to call on the energy and enthusiasm of those who have built the existing program and give them the support they deserve.

The sustainability of the components of the CCFAP that are not within the parameters of a hospital’s budget is being accomplished through the efforts of CCFAP team members. The CCFAP has served as a catalyst for CCFAP teams to write successful grants for the future funding of individual program components. The CCFAP team members use the data being collected about the program at their site to approach outside funding sources.

The CCFAP is a proactive response to the fact that > 7 million Americans are caregivers to family members, primarily to spouses or parents who are being treated in ICUs for severe and, often, long-term illnesses. Many times, these caregivers face the strain of traveling long hours, being away from home for days or weeks at a time, catching naps on waiting room couches, and grabbing snacks from vending machines. They do this while collaborating with physicians and nurses, and making decisions that are literally about life or death for their loved one. Hospitals have felt the need, for some time, to attempt to remedy this situation and have each made individual, sporadic efforts to ameliorate it.

What should be underscored is the emphasis on teamwork and the enthusiasm that has greeted the introduction of the CCFAP. Critical care in the United States is delivered by a multidisciplinary team of professionals who work together to provide the intense monitoring and care that is needed for critically ill patients. The team is headed by a physician, and includes nurses, pharmacists, respiratory therapists, nutritionists, social workers, chaplains, and, in some cases, bioethicists. It was anticipated that the introduction of a new program would require expending significant time and energy in overcoming the resistance to change that is normally found in any setting. As the CCFAP has entered our hospitals, it has been greeted with very strong support, obviously meeting an unfulfilled need throughout the hospital. While considerable time has been devoted to planning and implementation, very little energy has been needed to overcoming any resistance. Those who initially questioned the implementation of the CCFAP were soon convinced of its value by demonstrated results.

A most encouraging aspect to the introduction of the CCFAP has been the teamwork that has been exhibited and the close cooperation that now exists between units that formerly had little direct interaction. The redesign of waiting rooms had physicians and nurses working in close collaboration with facilities departments. The need to develop computer kiosks with information that is important for families brought about new working relationships with the staff who control instructional technology. Chaplains and social workers who had always collaborated with the critical care unit found common cause with the ICU staff in devising better ways of bringing information and comfort to family members. The need to disseminate information about the CCFAP required the expertise of the public relations department in placing articles and developing information brochures. Other individuals and departments were asked to provide support, and have responded with energy and enthusiasm. While the ICU team adopted a leadership role, other hospital staff responded admirably when called on to support the efforts of the team.

The CCFAP program has encouraged a special initiative involving the ICU and has empowered individuals to exercise their creativity in supporting the program. Examples abound of staff members approaching local merchants and requesting donations for needed items. Contributions of electronic equipment for providing information, as well as for offering relaxation, have been solicited and received. Others have approached local businesses for partial assistance with food, transportation, and lodging vouchers. The response from the community has been gratifying. Each of these joint endeavors has strengthened the bond between the hospital and the local community, and has fostered a pride of ownership in the CCFAP program that is special, if not unique. Within the hospital community, the unofficial word about the program has traveled faster than the official announcements. As a result, other departments have expressed interest in being able to develop a similar program to meet the needs of patients and their families.

In looking at the CCFAP, based on the data from the relatively short period it has been operating, administrators have been gratified by the response from staff and from family members of critically ill patients. Both administrators and staff have received letters and calls thanking them for introducing the CCFAP, and praising both the excellence of the medical services their loved one received and the comfort and support they received from the entire staff. The CCFAP collects data from families on a variety of areas indicating their satisfaction with services. These surveys have indicated a favorable response to the program and have contained numerous helpful comments about other services to integrate in the future. Currently, research commissioned by The CHEST Foundation is seeking to examine the CCFAP family satisfaction survey offered and is attempting to correlate the results with those of the quality surveys that the hospitals are using to assess care across all departments.

In providing assistance to the families of patients in the ICU through the CCFAP, hospitals have met not only the needs of these families, but also many of the concerns of staff. Research conducted in each hospital with families and staff has indicated that the CCFAP has resulted in reduced stress for families, increased support and cooperation among staff members, and greater communication between staff and families. Additional research will indicate other long-term benefits for families and for the hospital, including reduced lengths of hospital stay, increased staff retention, decreased legal action, an improved and coordinated system of care, and an increased professional knowledge base about serving the families of critically ill patients.

Abbreviation: CCFAP = Critical Care Family Assistance Program




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