On the heels of its 300th lung transplant on Tuesday and national recognition for its quality care this month, Emory Healthcare is continuing to improve its care by involving patients and families where they have traditionally been closed off.

Emory Healthcare embarked on an initiative to implement a patient/family-centered model of care four years ago, prompted by the realization that family presence not only facilitates the healing processes, but also provides caregivers a resource that can inform treatment.

“The purpose of patient/family-centered care is involving patients and families in a very different way than in the past. We engage them more actively in patient care, recognizing that patients’ family members are often key to their recovery, and that they possess information about their loved ones that we might not have had,” Chief Nursing Officer Susan Grant said.

Emory Healthcare hospitals now allow family presence during many code situations — a time when hospital caregivers traditionally have barred family members from the room, Grant said. She said family members who have chosen to be present find that witnessing emergency care helps them better understand what happened and gain closure if a loved one passes away.

Family members who transport the patient to the hospital are the ones who can best describe the details leading up to the emergency situation, she said, and their presence allows for ongoing dialogue with the medical team as care is delivered.

“Allowing family presence takes the mystery out of what happened. Family members would be able to see what the care team is doing to help their loved ones instead of being cut out of the process and made to wait,” Grant said. “There would be more transparency.”

Grant said family presence during code situations is not common because caregivers often assume family members would be traumatized. But what Emory Healthcare personnel have realized is that many families feel more traumatized when kept in the dark and then delivered bad news after hours of unknowing anticipation, Grant said.

Emory Healthcare has also integrated its patient/family focus in everyday care. Rather than the day nurse handing off a bedside report to the night nurse, patients and families at Emory Healthcare hospitals are now encouraged to report their own observations of what worked and what did not.

While caregivers in most hospitals in the country typically set goals for their patients, Grant said, Emory Healthcare prompts its patients to set their own goals. For example, she said, health care providers might outline goals such as taking certain tests or starting medications on a certain day. But a patient’s goal may be to contact a family member to take care of a non-medical issue that could otherwise impose unnecessary stress and hinder the patient’s recovery, she said.

In addition, Grant said Emory Healthcare is moving toward eliminating set visiting hours in favor of open visiting hours, and is likely to reach that goal by the end of the year. A majority of Emory Healthcare areas already have very flexible visitation policies that allow family members to spend the night with their loved ones, she added.

Furthermore, the Intensive Care Unit (ICU) at Emory University Hospital is physically designed to facilitate family presence. Each ICU unit has a room attached with areas for family members to lay down when they spend the night. However, Grant emphasized that physical design alone does not indicate a patient/family focus.

“It has to be all of the above, a real commitment to patient/family-centered care,” Grant said. “Areas like the emergency departments and many ICUs are often some of the most patient/family-centered, though the [physical] design is old.”

Emory Healthcare’s commitment to patient/family-centered care stems from the belief that family presence can lead to better care for the patient at all points in the diagnosis, treatment and healing process, Grant said.

This in turn leads to not only better quality but also less time spent at the hospital and lower costs, she added.

“In the past, we used to keep patients in the hospital for weeks at a time because we felt as though we were the only ones who could take care of them. Now, over the last few years, length of stay has been reduced, costs have been reduced, we’ve moved patients out into their home settings or less expensive settings,” Grant said. “I think patient/family-centered care comes into this in that if they have the information they need, we can prepare them to take care of themselves.”

Grant said another extension of patient/family-centered care is educating family members on how to care for their loved ones post-hospital stay to avoid readmission and to ensure safety.

Once health care providers have done all that they can, Grant said, family members and patients must be equipped with enough knowledge to be proactive in recovering and staying healthy.

Patient care at Emory Healthcare has also improved in quality through protocols developed to ensure patient safety while at the hospital. For example, bedridden patients are particularly susceptible to developing blood clots in their legs from lack of movement, and those who are on ventilators are at risk of contracting pneumonia, which can lead to fatal consequences. Emory Healthcare takes measures to monitor these vulnerabilities to ensure that patients receiving care stay safe.

“These risks are not small. They impact mortality. We do everything we can to prevent infections, and it has led to decreased mortality rates,” Grant said. Emory Healthcare has a mandatory flu vaccination policy.
“Patient/family-centered care is really about providing an environment where families can participate actively to make the outcome better for their loved ones,” Grant said. “It’s about how to engage them differently so that they play an active role in making sure loved ones get what they need, even once they leave the hospital.”

— Contact Tiffany Han.