Grant Recipient: 

Children’s Research Institute  of Children’s National Medical Center (CNMC)

Title:

Family Presence During Pediatric Trauma Activation: Measuring the Effects of a Multidisciplinary Approach to Patient-family Centered Care 

Project Period:

September 1, 2008- August 31, 2011

Project Team:

This multi-site collaborative study includes teams from Children’s National Medical Center, Dallas Children’s Hospital, and Children’s Hospital of Philadelphia. 

Children’s National Team: Karen O’Connell, MD (primary investigator); James Chamberlain, MD; Robert McCarter, MD; Cathy Guzetta, RN, PhD; Jennifer  Hinrichs, MSN, RN; Philip Guzetta, MD; Barbara Kreling, MSPHS; Anne Mechorikunnel, LMSW; Robert McCarter, ScD; Saeid Goudarzi; Jianping He, MS; Bobbe Thomas; and Rachel Townsend

Dallas Children’s Team: Pam Okada, MD; Steven Megison, MD; and Ben  Retta, LMSW

Philadelphia Children’s Team: Jill Baren, MD; Michael Nance, MD; and Cynthia Thomas, MSW

Background:

Family-centered care has long been advocated as part of the EMSC mission. When treated as one unit, parents and children both fare better in the health care system. Both the federal EMSC Program and multiple partners providing care for children have developed position papers in support of pediatric family-centered care. To date though the impact of family presence during the provision of pediatric emergency care under extreme stressful experiences, such as resuscitation, (both medical and trauma) has yet to be systematically evaluated. The goals of this grant are (1) to study the effects of family presence on the timeliness and effectiveness of care during pediatric trauma team “activations,” as well as assessing families’ and providers’ attitudes and experiences related to family presence and (2) to develop and disseminate a toolkit to assist other emergency departments with the implementation of family presence procedures in their hospitals.

Project Progress:

2010-2011

• Team begins to develop a toolkit to facilitate hospital implementation of family presence during trauma resuscitation programs.
• The enrollment of patients continues until thresholds are obtained for each study group.
• Team completes the redesign of the implementation processes to enhance engagement of families in telephone interviews and focus groups.
• A technical assistance site visit is held involving the project team and staff from HRSA, the NRC, and NEDARC, as well as family representatives from Texas and Pennsylvania. The visit focuses on data analysis and enhancing family engagement in the study.  
• Team conducts a preliminary review and cleaning of data collected to date.
• Planned patient/family enrollment of 1,023 is exceeded. The total patient enrollment to date is 1,295, including 931 families present for trauma resuscitation and 364 families not present at trauma resuscitation. 

2009-2010

• Enrollment of patients, family, and staff in study, including focus groups,  interviews, and staff surveys continues at all study sites.   

2008-2009

• Enrollment of patients, families, and staff in study begins at all sites.
• Team develops a consistent format design for contacting families to elicit participation in project, including participation in follow-up telephone interviews and focus groups.
• Team defines the health care provider focus group design.
• Team develops and validates survey tools describing experiences and attitudes of health care providers who have experienced pediatric trauma resuscitation both with and without family presence.
• Team designs and tests the database for patient enrollment and data collection.
• Team develops, validates, and implements the policy and procedures for model family presence during trauma resuscitation. This policy provides a consistent approach for implementation at all three project sites.

Dissemination and Sustainability:

This grant has resulted in the following publications:

• J Kingsnorth, K O’Connell, C Guzzetta, J Edens, S Atabaki, A Mecherikunnel, K Brown. (March 2010). Family presence during trauma activations and medical resuscitations in a pediatric emergency department: An evidence-based practice project, Journal of Emergency Nursing, 26:2, 115-121.

This grant has resulted in the following presentations:

• Family Presence during Resuscitation. Council for the Advancement of Nursing Science, Washington, DC; Sept 2010
• Family Presence during Pediatric Trauma Team Evaluation. Pediatric Resuscitation Research Team Seminar, Children’s National Medical Center; Dec 2010.
• Family Presence in Resuscitations: Research, Policies & Practice. The Emergency Nurses Association: Pediatric Emergency Care Workshop, Easton, Maryland; Feb 2011.
• Family Presence in Resusctitations. The 20th Annual Barbara Proctor Memorial Education Day: Mid-Maryland Emergency Nurses Association Educational Seminar, Silver Spring, MD; Sept 2009
• Implementing Family Presence during Trauma/Code Blue Resuscitation: An Evidence-Based Pilot Evaluation, Washington Hospital Center, Nursing Grand Rounds, Washington, DC; Feb 2010
• Family Presence During Trauma Activations and Medical Resuscitations in a Pediatric Emergency Department: An Evidence-Based Practice Demonstration Project, Eastern Nursing Research Society, Providence, Rhode Island; March 2010
• Understanding Family Presence during Trauma Team Activations: Using Triangulation to Get to the Heart of the Experience (Poster), Children’ Research Institute 2010 Research Day, Children’s National Medical Center, Washington, DC; April 2010
• Understanding Family Presence during Trauma Team Activations: Using Triangulation to Get to the Heart of the Experience (Poster).  Annual EMSC Program and Grantee’s Meeting, Bethesda, MD; May 2010

Emerging Projects

In collaboration with the EMSC National Resource Center, the team is developing a online toolkit to facilitate hospital implementation of family presence during trauma resuscitation programs.

Recognitions

In 2009, the team received Children’s National Medical Center 10th Annual Research Day Faculty Honorable Mention Award for “Family Presence During Trauma Team Activation: Using Triangulation to get to the Heart of the Experience”