Current practices related to family presence during acute deterioration in adult emergency department patients

AIMS AND OBJECTIVES: To explore the characteristics of and interactions between clinicians, patients and family members during management of the deteriorating adult patient in the emergency department. BACKGROUND: Previous research into family presence during resuscitation has identified many positive outcomes when families are included. However, over the last three decades the epidemiology of acute clinical deterioration has changed, with a decrease in in-hospital cardiac arrests and an increase in acute clinical deterioration. Despite the decrease in cardiac arrests, research related to family presence continues to focus on care during resuscitation rather than care during acute deterioration. DESIGN: Descriptive exploratory study using nonparticipatory observation. METHODS: Five clinical deterioration episodes were observed within a 50-bed, urban, Australian emergency department. Field notes were taken using a semistructured tool to allow for thematic analysis. RESULTS: Presence, roles and engagement describe the interactions between clinicians, family members and patients while family are present during a patient's episode of deterioration. Presence was classified as no presence, physical presence and therapeutic presence. Clinicians and family members moved through primary, secondary and tertiary roles during patients' deterioration episode. Engagement was observed to be superficial or deep. There was a complex interplay between presence, roles and engagement with each influencing which form the other could take. CONCLUSIONS: Current practices of managing family during episodes of acute deterioration are complex and multifaceted. There is fluid interplay between presence, roles and engagement during a patient's episode of deterioration. RELEVANCE TO CLINICAL PRACTICE: This study will contribute to best practice, provide a strong foundation for clinician education and present opportunities for future research.