ENA Releases Report on
Family-Centered Care Practices in EDs

As reported by EMSC NEWS

Pediatric emergency care requires assessment and intervention to meet the physiologic needs of pediatric patients as well as the psychosocial and emotional needs of children and their families. An interdisciplinary approach that supports and involves the family in the emergency care process is vital both for the child and his or her family. However, a family-centered care model is not a standard approach in many emergency departments.

Recognizing the significant role of families in the continuum of emergency services, the Emergency Medical Services for Children (EMSC) Program and the Emergency Nurses Association (ENA) support a family-centered approach. In 1999, ENA received a Partnership for Children contract to assess family-centered care practices in nine emergency departments (ED) using the Family-Centered Pediatric Care in the Emergency Department Assessment Tool. Four general EDs serving adults and pediatric patients and five pediatric EDs participated in the pilot.

The tool is organized into eight sections:

• Vision, Mission, and Philosophy of Care;
• Family Participation in Care;
• Family Support;
• Information and Decision-making;
• Services Coordination and Continuity;
• Personnel Practices;
• Evaluations/Continuous Quality Improvement; and
• Community Partnerships.

Study Results

Each participating hospital had a description of its vision and/or mission statement posted in locations visible to the public and staff. However, only two hospitals articulated the role of the family in their statements. Four EDs developed a department-specific mission statement, which was derived from the hospital mission. Of the four, two EDs had statements that were specific to the family and one included specific language regarding family-centered care.

The level of family participation in care varied across institutions, and in some cases, varied within the department based on the age of the patient and/or the staff on duty. In each department, parents or the primary caretaker were recognized as an important source of information about the child and the child's condition and most hospitals involved them in the routine care of pediatric patients. Family participation during critical and resuscitation events was more variable. Factors identified as impacting the consistency and/or timing of family participation or presence during the events included visitation policies, space limitations, privacy of other patients in curtained areas, and family reactions and understanding of critical situations.

Each department had a system for providing information to families upon their arrival and a staff person designated to provide information periodically during critical situations. Only two departments offered 24-hour, in-house social work and/or pastoral care services. Others offered the services for 8 to 16 hours per day and provided on-call systems. One department had no formal on-call system for social work after 5 p.m.

None of the EDs provided structured supervision of children in the waiting area. All EDs recognized a need for toys. However, the availability of these items varied among departments. General support services, such as language interpreters, social workers, chaplains, and security guards were available to all of the EDs.

Each ED reported that parents were engaged in developing a plan and were provided choices in treatment approaches during most situations. When agreement between the emergency staff and family had not been the child's primary care provider to help problem solve the issue. Verbal and written discharge instructions, including follow-up care and other necessary services, were provided in all of the EDs. Six EDs provided written instructions on caring for selected problems in languages other than English.

All of the departments reported that communication with the child's primary care provider was an important aspect of care coordination. Seven EDs had special mechanisms for referring patients to a primary care provider. Referral to or information about rehabilitation services, respite care, specialized childcare, early childhood intervention, special education, and clearinghouses or web sites was not routinely provided. None of the EDs were involved in discharge planning or emergency care plans for children with special needs other than what was required following an ED visit.

Color-coding, directional floor materials, or themes were used to provide directions in six hospitals. Other environmental and design elements assessed in the study included parking locations; waiting area comfort and space; provisions provided to parents at their child's bedside; ease of access to cafeteria and other common areas; and availability of services, such as telephones, ATMs, vending machines, and the like.

Each ED used a written survey to evaluate patient satisfaction with the visit. Four of them used additional surveys, suggestion boxes, and/or follow-up phone calls routinely while five used focus groups and two consulted with a family advisory group to obtain family input.

Eight EDs had staff who were involved in community outeach, education programs, and/or injury prevention initiatives. While the level of family participation in hospital programs varied, the role of the family in education, fund raising, public awareness, and public policy was recognized withinall of the organizations.

Conclusion

The assessment tool provided a means to evaluate family-centered care strategies in relation to various policies, procedures, program structures, and haelth care practices within the ED. This study provided an opportunity for the staff and/or management of each ED to identify current family-centered care practices and opportunities to strengthen them.

Organizations intereted in conducting a self-assessment may obtain the Family-Centered Care in the Emergency Department Assessment tool by contacting the Emergency Medical Services for Children (EMSC) National Resource Center at (202) 884-4927.

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