Co-designed PICU Family Stress Screening and Response System to Improve Experience, Quality, and Safety

Abstract

Objective: Evidence for successful and sustainable models that systematically identify and address family stress in the pediatric intensive care unit (PICU) remains scarce. Using an integrated improvement science and family engagement framework, we implemented a standardized family stress screening tool and response protocol to improve family experience and reduce family crises through the timely coordination of parent support interventions. Methods: We conducted this improvement initiative in the 12-bed PICU of a children’s hospital within a large, urban academic medical center. Our team, which included 2 family advisors, adapted a validated Distress Thermometer for use in pediatric intensive care. A co-designed family stress screening tool and response protocol were iteratively tested, refined, and implemented in 2015–2017. Process and outcome measures included screening and response reliability, parent satisfaction, and security calls for distressed families. Results: Over the 18 months, the percentage of families screened for stress increased from 0% to 100%. Among families who rated stress levels ≥5, 100% received the recommended response protocol, including family support referrals made and completed within 24 hours of an elevated stress rating. From 2015 to 2017, PICU parent satisfaction scores regarding emotional support increased from a mean score of 81.7–87.0 ( P < 0.01; 95% CI). The number of security calls for distressed families decreased by 50%. Conclusions: The successful implementation of a co-designed family stress screening tool and response protocol led to the timely coordination of parent support interventions, the improved family perception of emotional support, and reduced family crises in the PICU.

Provider’s Perception of Parental Anxiety in the Pediatric Intensive Unit

“…Liaw et al, in a quality improvement initiative, screened the parents of critically ill children for stress and provided focused support [18]. They reported better family satisfaction and lower parental distress [18]. Our study reaffirms the magnitude of stress and subsequent anxiety that parents of critically ill children experience; and demonstrates poor recognition and assessment of parental anxiety when the provider's perception, rather than a validated screening tool, is used.…”

“…Recognition of parental stress and anxiety allows for early intervention and more focused family support. Liaw et al, in a quality improvement initiative, screened the parents of critically ill children for stress and provided focused support [18]. They reported better family satisfaction and lower parental distress [18].…”

Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence

“…Three PICU teams attempted a universal screening approach, though all missed some families due to limitations during roll-out, families declining to participate, or patients discharging before assessment could be completed. The first PICU team implemented a standardized family stress screening tool and response protocol [ 55 ]. The assessment was led by a provider with “expertise in assessing family stress/coping and ability to address family needs” [ 55 ].…”

“…The first PICU team implemented a standardized family stress screening tool and response protocol [ 55 ]. The assessment was led by a provider with “expertise in assessing family stress/coping and ability to address family needs” [ 55 ]. Compared with families admitted before the protocol rollout, screening was associated with increased parent satisfaction and decreased security calls for distressed families.…”

The Psychological Impact on Relatives of Critically Ill Patients: The Influence of Visiting Hours

“…There is neither a standard definition nor a validated tool in the literature for screening for psychologic distress in patients and/or relatives during an adult ICU stay. Some groups have designed specific tools for the screening of psychologic distress for family members of pediatric patients (21). The expression of psychologic distress varies over time and is derived from multiple factors (22).…”