Letting Families Stay in the Trauma Ward

 By ANAHAD O'CONNOR

It is a common scene in television hospital dramas: A critically injured child is rushed into an emergency room, doctors racing furiously to save him. A frantic mother shows up, desperate to stay by her child’s side, and instead is hustled out of the way and asked to wait outside.

 Many hospitals have traditionally sought to keep family members out of trauma wards.

Many emergency care workers believe that a family’s presence can distract the medical team in these critical moments. But a new study suggests that having loved ones present in the trauma ward when children are being treated has no detrimental effect on their care. In the study, medical teams performing invasive and potentially lifesaving procedures at Children’s National Medical Center, a Level 1 trauma center in Washington, D.C., that receives the most serious injury cases, did just as well whether family members were present or not.

The practice of allowing loved ones in the trauma ward has been a contentious one for years. Many hospitals have traditionally sought to keep family members out, worried that hysterical relatives might undermine medical workers’ ability to concentrate or physically get in the way. But in the last decade, more and more hospitals have warmed to the practice as various medical associations have come out in support of it, including the American Academy of Pediatrics, the American College of Surgeons and the American Heart Association.

“Families feel that it is their right to remain with their child,” said Dr. Karen O’Connell, lead author of the study and an attending physician in pediatric emergency medicine at Children’s National. “Parents feel that their presence really helps comfort the child, and we’ve seen from research that it does — it does help them cope with the pain.”

Still, according to the most recent data, fewer than 10 percent of hospitals nationwide have written policies in place for dealing with patients’ relatives. That means that in most hospitals, the policy can change from one day to the next.

“The practice is variable, and it makes it really hard for families of patients because sometimes they can stay and sometimes they’re asked to leave,” Dr. O’Connell said.

To determine the effects of family members’ presence, Dr. O’Connell and her colleagues at Children’s National spent four months monitoring the hospital’s trauma ward, using video cameras to record the response to a variety of serious injuries: falls from heights, car accidents, gunshot wounds. The researchers reviewed 145 cases involving patients under 16 years of age, 86 of whom had family members present while they were being treated.

The researchers looked at the thoroughness of the examinations the medical teams carried out when family members were and were not there, and compared how long it took medical staff to assess patients’ airways, neurological function and other critical aspects of a standard protocol for treating traumatic injuries.

Ultimately, whether family members were present or not, the researchers found no differences in the thoroughness of the exams performed and the amount of time in which the medical teams carried out lifesaving procedures.

Regardless of whether patients had relatives in the ward, for example, medical staff took just under a minute to assess airway function. Examining the abdomen, another critical early step, was completed in 97 percent of patients who had family members there and 98 percent of patients who did not. There were no instances in which a family member interfered with care.

The findings were presented over the weekend at the Pediatric Academic Societies annual meeting in Boston. Dr. O’Connell said that she and her colleagues would continue studying the issue with the aid of a federal grant and hoped to develop “a tool kit that will include lessons learned and methods on how to implement family presence in emergency rooms across the country.”

“Parents are the child’s main advocate,” Dr. O’Connell said. “They have all this personal and medical information about the child, and so when the child is in a critical situation, they can answer questions for the team and they can be there for them once the child is discharged.

“It’s really important for them to see the care from beginning to end,” she said, “and to understand what the healing process is going to be like.”