Family members do not disrupt care when present during invasive procedures

Abstract

Objective: To determine whether family members (FMs) remaining with pediatric patients during invasive procedures interfere with delivery of care.

Methods: The authors conducted a prospective observational study of consecutive patients <18 years of age undergoing invasive procedures in the emergency department (ED) over a one-year period. Behaviors of FMs remaining during invasive procedures were recorded as any of six categorical descriptions (stood quietly, asked questions, soothed patient, helped restrain patient, interfered with care, other). All observations were made through direct observation by two study attending physicians on FMs of patients under their direct care, or during their supervision of resident care.

Results: Fifty-four FMs were observed during the ED care of 37 patients [mean age 1.5 years (+/-0.25), median age 0.4 years]. Invasive procedures included: lumbar puncture (n = 28), endotracheal intubation (n = 5), fracture reduction (n = 2), shoulder reduction (n = 1), and tube thoracostomy (n = 1). Seventy-one FM activities were recorded: stood bedside, 22 (31%); soothed child, 21 (30%); asked questions, 11 (16%); helped restrain, 5 (7%); interfered with care, 2 (3%); and other, 10 (15%). The two "interfered with care" events were minor and did not significantly alter patient management. One mother experienced a near-syncope event standing during a lumbar puncture of her child and was seated without further incident. One mother stopped reduction of a shoulder dislocation because she felt the pain control was inadequate even though the child was deeply sedated with propofol. Expected patient behavior was described to the mother and reduction was completed.

Conclusions: In this study, family members remaining with children during invasive procedures were not a risk for disruption of patient care.