Liz Kowalczyk writes in the Boston Globe today about plans by Brigham and Women's Hospital to improve access to families of patients in its intensive care units. The Brigham is just completing a new building, and they have designed the ICU rooms to have sufficient space and amenities to permit family members to stay overnight. Here is the significant excerpt:
The rooms will be as big as 350 square feet - about double the size of the hospital's current rooms - and patients will be able to designate a relative or friend to stay with them each night, basically living alongside them in the room.
Doctors and nurses will encourage family members to help provide basic care, such as bathing and changing bandages, and allow designated individuals to remain in the room for most procedures, including removal of chest tubes, insertion of intravenous lines, and even resuscitations.
This is really an excellent step, and the Brigham deserves credit for including the possibility in the design of the new space -- but mainly for adopting medical rules and regulations that encourage this type of care.
In this regard, we are behind at BIDMC. As noted by a recent patient in a letter to me: "The ICU staff generally still sees family as outside of the direct care system.... The first night in the ICU was really awful, in that the visiting hours were strictly imposed, and we were allowed 2 people to visit her for five minutes every other hour. The nurse would look up at the clock when we entered, a kind of visual cue that she was counting. I’d strongly encourage (maybe, beg) for you to reconsider this policy in the ICU and throughout. I was told that the policy was in place for several reasons, but that the staff would never keep a family and a dying patient apart. I agree but think you are missing some wonderful energy and resources by placing limits in non-terminal situations."
So thanks to the Brigham for setting a great example. We are currently reviewing our own regulations to figure out what changes we should make. Likewise, in designing new ICUs and other rooms, we will be sure to make this a physical possibility. (By the way, the decision by the Brigham to expand the normal size of a room clearly adds costs. I think many would agree that this is money well spent, but I wonder if any of the insurers out there reading this would want to comment on how they feel about paying for this.)