Factors Affecting Family Presence During Fracture Reduction in the Pediatric Emergency Department.

Albert Zhang,Aimee Broman,Michael Repplinger,Michael Kim,Regina Yocum

doi:10.5811/westjem.2018.9.38379

Abstract

IntroductionAsking family members to leave during invasive procedures has historically been common practice; however, evidence-based recommendations have altered the trend of family presence during pediatric procedures. The aim of this study was to determine factors related to family members’ choice to be present or absent during fracture reductions in a pediatric emergency department (ED), and their satisfaction with that choice.MethodsWe administered role-specific, anonymous surveys to a convenience sample of patients’ family members in the ED of a Level I pediatric trauma center. All family members were given a choice of where to be during the procedure.ResultsTwenty-five family members of 18 patients completed surveys. Seventeen family members chose to stay in the room. Family member satisfaction with their decision to be inside or outside the room during the procedure (median = very satisfied) was almost uniformly high and not associated with any of the following variables: previous presence during a medical procedure; provider-reported procedure difficulty, or anxiety levels. Family member perception of procedure success (median = extremely well) was also high and not associated with other variables. Location during the procedure was associated with a desire to be in the same location in the future (Fisher’s exact test, p=0.001). Common themes found among family members’ reasons for their location decisions and satisfaction levels were a desire to support the patient, high staff competence, and their right as parents to choose their location.ConclusionFamily members self-select their location during their child’s fracture reduction to high levels of satisfaction, and they considered the ability to choose their location as important.

Highlights

Asking family members to leave during invasive procedures has historically been common practice; evidence-based recommendations have altered the trend of family presence during pediatric procedures
Asking family members to leave during invasive procedures has historically been common practice, evidencebased recommendations have altered the trend of family presence during pediatric procedures
Main Results There was no statistical difference between family member type and their actual location during the procedure: Mothers remained in the room in 86% of cases compared to 50% for fathers (p=0.08)

Summary

Introduction

Asking family members to leave during invasive procedures has historically been common practice; evidence-based recommendations have altered the trend of family presence during pediatric procedures. Studies have refuted the misperceptions that family members may interfere during the procedure, that the procedure may cause great distress to them, or that they do not have a preference regarding their own presence.[3,4,5,6,7] Other studies have suggested that a provider’s preference against family member presence is correlated with that provider’s lack of experience having family present and that providers’ views on family presence differ from patients’ views.[8,9,10,11,12,13,14] family presence may have beneficial effects on the patient-doctor relationship and patients’ medical outcomes.[15,16] Despite these findings, few studies have investigated family member presence during fracture reductions and other orthopedic procedures, which are common in emergency departments (ED). This study aimed to identify factors that affect the decision to stay in a patient’s room during a fracture reduction as well as to describe family members’ self-reported experience during the procedure

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