Physician support, formal policy key for family access

Flexibility is the key word when developing a policy on family access, says Stephen Epstein, MD, MPP, spokesman for the American College of Emergency Physicians and clinical operations director at Beth Israel Deaconess Medical Center in Boston. Understanding the family’s needs is important, but they must be balanced with patient safety.

Epstein offers these additional tips:

Obtain physician support when developing a policy. Be prepared for some physicians to resist the idea, mostly because they fear the family members may be upset by what they see or because the family might interfere with treatment. Emergency physicians don’t want to be distracted from the patient, so you will have to reassure them that those fears very rarely materialize. Show them the research that proves it. 

Consider practical matters such as the room size. No matter how good an idea it is to allow family access, you may face insurmountable obstacles. If your trauma bay is tiny and crowded, it’s not a good idea to introduce a family member and escort.

Maintain patient’s privacy. Having family members stand in the hall and look through an open doorway is not a good solution. That exposes the patient to anyone else who happens to walk by.

Allow personal touching if possible but not at the risk of patient safety. It’s important that the family member be able to hold the patient’s hand, and you should allow that touching as much as is practical. But in a resuscitation, for instance, there’s too much activity going on, and you should have the family stand back. The patient’s treatment needs come first.

Have the family escort help decide what the family wants to see. Not every family member will be willing or able to watch. What they can and can’t tolerate will vary greatly from one individual to the next. But the research suggests that most family members can tolerate very graphic efforts and still want to be present.

Make sure the escort is ready to take family members out if they are disruptive in any way. The family should not interfere with treatment, either physically or by talking critically to the staff. If family members can’t be calmed, the escort should take them out.

Establish that the physician running the resuscitation has the final say about family presence. The patient’s care comes first, so the physician must have veto power over the family presence. But that is why it is important to work closely with the physicians when developing the policy, so that they understand the need for family presence and don’t automatically say no in the heat of the moment.