Challenge of change: incorporating family members in hospital care.

C ulture is difficult to change, particularly when created and maintained within formal institutions. The culture of the hospital, as reflected in its specific practices, rules, and policies, seems particularly resistant to change. From its historical roots as a hierarchical structure focused on maintaining patient safety, hospitals have a long history of limiting information about the patient (eg, minimizing access to the medical record and even the diagnosis) and restricting visitors. Today, however, the hospital is slowly evolving to a structure that supports patient-centered care and open communication among patients, families, and caregivers. The article by Goldberger et al 2 focuses on a policy adopted by some hospitals that allows family presence during resuscitation (FPDR). The focus of their study provides an interesting insight into the traditions and culture that underlie many hospital practices, as well as the resistance that some physicians and nurses feel about having families participate in the care of acutely ill patients, particularly during a cardiac arrest. The authors compared the clinical outcomes of patients who had an in-hospital cardiac arrest in institutions that allowed FPDR compared with those that did not allow FPDR to address the concern expressed by clinicians and hospital administrators that FPDR is detrimental to patient care. Goldberger et al 2 compared the 2 categories of hospitals (those who allowed FPDR versus those who did not) on the proportion of patients who experienced a resuscitation event and had a return of spontaneous circulation, the neurological status of survivors, and the proportion of patients who lived to hospital discharge. The study is strengthened by the large number of cases included and the number of clinical outcomes included, but has the limitations of all secondary analyses. The data were gathered for purposes other than to determine the result of FPDR on patient outcomes, and the investigators could not verify whether family members were actually present during a resuscitation event regardless of hospital policy about FPDR. The inability to analyze the data based on actual family presence is a major limitation of the study. Also, it must be noted that a finding of no difference between 2 groups is always less compelling scientifically than the finding of a difference. Despite these limitations, the results of this study answer an important question about the safety of FPDR. The questions surrounding FPDR are not new and, in fact, were posed almost 3 decades ago. 3 Many clinicians …