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. 2019 Mar 7;4(2):e145.
doi: 10.1097/pq9.0000000000000145. eCollection 2019 Mar-Apr.

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

K Ron-Li Liaw  1   2 , Jeanne Cho  1 , Lea Devins  3 , Jennifer Daly  1 , Dennis Sklenar  4 , Yasir Al-Qaqaa  5
Affiliations

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

K Ron-Li Liaw et al. Pediatr Qual Saf. .

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.

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Figures

Fig. 1.
Fig. 1.
KDD to enhance emotional support for families and to prevent a crisis. KDD indicates key driver diagram. SMART; A SMART aim is an aim that is specific, measurable, achievable, relevant and timely. YAC; Youth Advisory Council.
Fig. 2.
Fig. 2.
Family Stress Thermometer screening tool.
Fig. 3.
Fig. 3.
PDSA cycle ramps completed to test and optimize key elements of family stress screening and response. FAQ indicates frequently asked questions; HIPAA, Health Insurance Portability and Accountability Act; MD, medical doctor; RN, registered nurse; SW, social work.
Fig. 4.
Fig. 4.
Process control P-chart of the % of families screened for stress during PICU admission. EPIC; electronic health record.
See this image and copyright information in PMC

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