Abstract Rationale Family-centered care in intensive care units (ICUs) improves communication, reduces distress and burnout, and is associated with better outcomes for patients, families, and clinicians. Despite professional society guidelines recommending family-centered care, implementation varies widely. We sought to characterize delivery of family-centered care practices in Veterans Affairs (VA) ICUs nationally and identify barriers to routine implementation to inform future improvement efforts. Methods We conducted a cross-sectional survey of all VA medical centers with ICUs between September 2024 and January 2025. One ICU leader (nurse manager or physician director) from each ICU completed the survey. We assessed the frequency of 18 family-centered care practices across four guideline-based domains: 1) family presence and participation in care, 2) resources for family members, 3) communication, and 4) integration of interdisciplinary personnel into the care team. Respondents also reported barriers to implementation. Results Of 145 eligible ICUs across 111 VA medical centers, 111 ICUs (response rate 77%) from 95 medical centers responded. Respondents represented all U.S. regions (Midwest 23%, Northeast 16%, South 42%, West 18%) and ICU complexity (level 1 (highest) 49%, level 2 18%, level 3 28%, level 4 (lowest) 5%). The most commonly reported practices that were provided to at least some Veterans were spiritual support (100%), palliative care consultation (99%), and nurse involvement in goals-of-care discussions (93%), which are all in the interdisciplinary personnel domain (Table). In contrast, practices designed to enhance family engagement were relatively uncommon, including use of family navigators (22%), family presence during bedside procedures (20%), and use of ICU diaries (13%). Commonly reported barriers to the delivery of family-centered care included lack of physical space (62%), insufficient staff or staff time (44%), inadequate staff knowledge or comfort with family-centered practices (39%), and ICU culture (31%). No barriers were reported in 7% of ICUs. Conclusions In the largest national evaluation of family-centered ICU care to date, we found substantial variation in the delivery of recommended practices. While spiritual and palliative services were widely available, family participation and newer engagement strategies were less common. Targeted efforts that address structural limitations, staffing constraints, education, and ICU culture are needed to better integrate families into ICU care. This abstract is funded by: VHA
Harlan et al. (Fri,) studied this question.