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

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The Hospital and ICU Environment The family perspective Sangeeta Mehta MD @geetamehta0 Sinai Health System & University of Toronto CCCF November 11, 2019
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Transcript of The Hospital and ICU Environment The family perspective environment... · The family perspective...

  • The Hospital and ICU Environment

    The family perspective

    Sangeeta Mehta MD


    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

  • 8

    Hospital environment



    Info on food & accommodation

    Food preparation facilities

    Sleeping in the hospital

    Shower facilities

    Religious/spiritual needs



    Waiting room

    Furniture, art, paint, plants

    Private space

    Natural light/air

    Informational material


    Visitor bathroom


    Television, computer, wifi

    Reading material

    Patient ICU room

    Sleeping facility for family


    Communication tool



    Natural light/air


    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)

  • 11

    Patient Age





    Visitor's Age

  • 12

    Relationship to Patient







  • Distance from Hospital


  • Distance from Hospital


    Have you slept in the waiting room?

    YESN=46 28%


    # nights: 1 2 3 4

    N 17 14 6 3

    Range: 1-7


  • 15

    Extremely important

    Very important82% 79% 79% 77%





  • Lower priority – Hospital environment

    • Childcare

    • Information about religious services

  • 17


    80% 78%



    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


    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



    Olausson, Intensive and Crit Care Nursing 2012

  • 29

  • 30

    Critical Care Patient Journey Map

  • 31

  • What do visitors to ICU prioritize…

    For patients


    •Natural light, fresh air

    •Dim lighting at night

    •White board


    For themselves

    •Open visitation




    •To sleep nearby or in the pt room


    •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

    [email protected]



  • 35

  • J of Pediatric Psychology 2008;33:292-297

  • 37

  • 38

  • 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


    •Overnight accommodations

    •Bathroom, shower