Family satisfaction scores increased after ICUs implemented family-centered care initiatives as part of the Society of Critical Care Medicine’s Family Engagement Collaborative.1

“Active participation of families in the care of critically ill patients in the ICU can help to mitigate conflicts regarding goals of care,” says Ruth Kleinpell, PhD, RN, FAAN, the study’s lead author and associate dean for clinical scholarship at Vanderbilt University School of Nursing.

ICU patients are incapacitated and often unable to speak for themselves. “We are meeting them with potentially no context on who they are as people,” says David Y. Hwang, MD, another study author and an associate professor in the division of neurocritical care and emergency neurology at the Yale School of Medicine. There is increasing recognition that families should be participants in ICU patients’ care, as opposed to just bystanders, according to Hwang.

Each of the 63 participating ICUs chose a specific initiative to implement. “We were surprised at the variety of initiatives they selected,” Kleinpell says. Some examples:

  • Make it easier for families to be at the bedside with open visitation;
  • Encourage families to be present during rounds to listen to what the plan is for their loved one that day;
  • Allow families to be present if the patient’s heart stops and CPR has to be performed. “The idea behind this is that it allows them to have some closure and see what was done to save their loved one’s life, with nothing left on the table,” Hwang offers.

The ICUs collected data on family satisfaction before the project, and again 10 months later. “The point of the study was to show that this collaborative model could really promote family engagement,” Hwang explains.

The study demonstrated families were more satisfied post-implementation. “It shows the value of connecting different sites, and understanding that other ICUs across the country are doing something similar,” Hwang says. “You don’t feel so lonely when you are trying to push one of these projects forward in your own unit.”

The COVID-19 pandemic stalled some of this progress. When ICU volumes surged in spring 2020, strict visitor restriction policies were put in place. “We went from 24/7 visitation to zero visitation, with maybe an exception here and there for an end-of-life situation,” Hwang reports.

ICUs have since worked through a number of iterations of visitor policies. “While we are not back to where we were before, we have slowly opened things up,” Hwang adds.

Family engagement is going to be challenging as long as families are not freely allowed at bedside. “The hope is, as areas are able to open up ICUs gradually and safely, the progress that’s been made over the past decade won’t be lost,” Hwang says.


  1. Kleinpell R, Zimmerman J, Vermoch KL, et al. Promoting family engagement in the ICU: Experience from a national collaborative of 63 ICUs. Crit Care Med 2019;47:1692-1698.