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Family presence during pediatric trauma team activation: an assessment of a structured program
Karen J O'Connell1, Mirna M Farah, Philip Spandorfer
1Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. koconnel@cnmc.org
Insights
Family presence during pediatric trauma evaluations is safe and effective. A structured program showed no negative impact on care, with most providers reporting improved decision-making and communication.
Area of Science:
- Pediatric Trauma Care
- Family-Centered Medicine
- Emergency Medicine
Background:
- Family members are often excluded from initial pediatric trauma evaluations.
- Concerns exist regarding potential interference with medical care.
- Structured family presence programs aim to integrate families into care.
Purpose of the Study:
- To evaluate outcomes of a structured family presence program during pediatric trauma activations.
- To measure the need for termination of family presence.
- To assess the impact on the timeliness of trauma evaluations and staff opinions.
Main Methods:
- Cross-sectional study combining prospective data and surveys with retrospective chart review.
- Conducted at a level 1 pediatric trauma center with an established family presence program.
- Compared trauma evaluation times and surveyed staff immediately post-evaluation.
Main Results:
- 197 family members participated with no interference in medical care.
- Trauma evaluation completion times did not differ significantly with or without family presence.
- Majority of providers reported family presence had no effect or improved decision-making, patient care, and communication.
Conclusions:
- Structured family presence programs have a low prevalence of negative outcomes in pediatric trauma.
- Excluding families routinely due to provider concerns is not indicated.
- Family presence can be safely integrated into pediatric trauma care.
Objective:
When a child presents to a trauma center with a serious injury, family members are often excluded from the initial trauma team evaluation. The objective of this study was to evaluate the outcomes of a structured program of family presence during pediatric trauma team activations by measuring (1) the need for termination of family presence, (2) times to completion of key parts of the trauma evaluation, and (3) the opinions of staff surveyed immediately after conclusion of family presence.
Methods:
This was a cross-sectional study that combined prospectively obtained data and surveys from trauma team evaluations in which family presence occurred, with retrospective chart review of all trauma activations during an 18-month study period. The study was conducted at a level 1 pediatric trauma center with a preestablished family presence program that assigns a staff member to screen family members for family presence, provide support, and record events. Times to completion of key components of the trauma evaluation were calculated and compared for cases with and without family presence. Cross-sectional surveys were performed immediately after each trauma team evaluation.
Results:
A total of 197 family members participated in family presence. There were no cases of interference with medical care by family members. Seven family members were asked to leave the trauma area by staff after initiation of family presence for various reasons. Times to completion of key components of the trauma evaluation did not differ significantly between enrolled patients with family presence and those without family presence. Surveys were completed for 136 cases, and the majority of providers reported that family presence either had no effect on or improved medical decision-making (97%), institution of patient care (94%), communication among providers (92%), and communication with family members (98%).
Conclusions:
This prospective study suggests that there is an overall low prevalence of negative outcomes associated with family presence during pediatric trauma team evaluation after implementation of a structured family presence program. Excluding family members as a routine because of provider concerns about negative impact on clinical care does not seem to be indicated.
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