City hospitals look at pulling back the curtain for ICU patients’ families

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This article was published 22/02/2017 (3454 days ago), so information in it may no longer be current.

Usually, it’s only when something goes critically wrong, that hospitals make headlines.

But there is something else that’s important, a cultural shift, that’s good news for everyone involved.

It was suggested in Saturday’s column in which the husband of a wife who died in the St. Boniface Hospital intensive care unit wrote about how his “Dearly Beloved” — in fact the whole family — had been treated during those life-and-death last days for Susan White.

“A story that needs telling,” was the subject line of Greg White’s email.

His letter went on to describe how, just two years ago, the hospital’s intensive care medicine/surgery unit, or ICMS, began an innovative approach to caring that focused on treating not only the patients in the beds, but caring for and communicating with the family as well. To the point where the health care team wants the family to be with them on daily medical rounds in the 10-bed, second-floor unit.

“They explain to family exactly what is going on and why,” Greg wrote. “They will spend as much time as possible fully answering any questions whatsoever. They constantly check on the family’s condition and will do whatever is needed for them, while working long hours in a very stressful environment. To a person, each member of the team is loving and compassionate to everyone involved. I know, because I was there from noon Monday until Thursday afternoon.”

Not only that, but Greg and his family felt embraced by the doctors and nurses who showed the same kind of compassion for them as they did for Susan.

He called what he wittnessed “a small miracle.”

Which is why I wanted to know more about a hospital practice that, at least anecdotally, seems so different from the norm. So this week I met with Dr. Gregg Eschun, the medical director for the St. Boniface Hospital intensive care unit, and Wendy Rudnick, the chief nursing officer.

Eschun called family presence a major cultural change.

“When we first started discussions around this,” he said, “it was such a culture shock to the health care team that there was some natural fear and trepidation.”

Rudnick could identify with that in a personal way, but a different time.

She recalled being a critical care nurse at Health Sciences Centre in the late 1980s and her first troubling experience during a time when hospitals kept families from going behind the curtain with doctors and nurses.

“I felt just absolutely terrible because we kept a family out, because we had to tend to all the medical procedures. That was time spent with the health care team, and not with the family to say goodbye.”

Rudnick also remembers her first glimpse at the future, maybe as long ago as 2000, when she was troubled again, but for a different reason. That moment involved Dr. Luis Oppenheimer, and his compassion for the family of a young woman who was close to death.

“He had the husband and the young family there, and we were doing a resuscitation. And he was just comfortable with having the family present,” Rudnick explained.

She said Oppenheimer calmly explained to the family what was happening, what was going to happen and what was likely to be the result.

“It was unusual,” Rudnick said.

It was more than that.

“It was a bit unnerving,” she acknowledged.

She meant for herself and the rest of the health care team attending with Oppenheimer.

“People were somewhat excited about the opportunity to have family present,” Rudnick said. “But they were also very nervous about what’s this going to look like. It was just unknown. It was: do we know what their emotions are going to be? How were they going to respond and react?”

Yet, as far as St. Boniface Hospital has come in the last two years — with its progressive, “family present” model — it still hasn’t come as far as Oppenheimer took the team that day so many years ago.

“We’re not quite there yet,” Eschun said.

But Victoria General, the other hospital Eschun credits with spearheading the “family present” movement in Winnipeg, does include families of adult patients during resuscitation. As does Children’s Hospital and St. Boniface Hospital neonatal intensive care.

Without the foresight of Dr. Kim Wiebe, though, we might not have come this far.

Wiebe was working as an assistant professor at the University of Calgary’s department of critical care when she witnessed families being involved in ICU care, and brought the idea back on her return to Winnipeg six years ago as medical director of St. Boniface’s intensive care unit.

It would be Eschun, Wiebe’s successor, who would implement it.

Greg White’s email to me about how he and his family felt about being included and embraced during his wife’s final days represents the kind of thank-you St. Boniface Hospital receives for its family-inclusive efforts in its intensive care unit, where — unlike other general wards — there’s a nurse for every bed.

But praise isn’t the only kind of feedback the medical team has received from families. And involving family sometimes has benefits that go beyond what doctors and nurses expect.

“More than once in my personal experience” Eschun said of family being present, “they’ve offered life-saving information that we didn’t know about: about past history, about allergies. That whole history is gold.”

Near the end of our conversation, I wondered if this kind of specialized care and caring would ever reach the rest of the hospital, where staffing levels and workloads are so different.

Eschun’s response was heartening, if not not convincing.

“I think society is going to demand it — eventually.”

gordon.sinclair@freepress.mb.ca