title: Policies allowing family presence during resuscitation and patterns of care during in-hospital cardiac arrest.
abstract: BACKGROUND
  A growing number of hospitals have begun to implement policies allowing for family presence during resuscitation (FPDR). However, the overall safety of these policies and their effect on resuscitation care is unknown.
  
  
  RESULTS
  We conducted an observational cohort study of 252 hospitals in the United States with 41,568 adults with cardiac arrest. Multivariable hierarchical regression models were used to evaluate patterns of care at hospitals with and without an FPDR policy. Primary outcomes included return of spontaneous circulation and survival to discharge. Secondary outcomes included resuscitation quality, interventions, and facility-reported potential resuscitation systems errors. There were no significant differences in facility characteristics between hospitals with and without an FPDR policy, nor were there significant differences in return of spontaneous circulation (adjusted risk ratio, 1.02; 95% confidence interval, 0.95-1.06) or survival to discharge (adjusted risk ratio, 1.05; 95% confidence interval, 0.95-1.15). There was a small, borderline significant decrease in the mean time to defibrillation at hospitals with an FPDR policy compared with hospitals without the policy (mean difference, 0.32 minutes; 95% confidence interval, -0.01 to 0.64). Resuscitation quality, interventions, and facility-reported potential resuscitation systems errors did not meaningfully differ between hospitals with and without an FPDR policy.
  
  
  CONCLUSIONS
  Hospitals with an FPDR policy generally have no statistically significant differences in outcomes and processes of care as hospitals without this policy, suggesting such policies may not negatively affect resuscitation care. Further study is warranted about the direct effect of FPDR attempts on adult patients with an in-hospital cardiac arrest and their families.
authors: From the Department of Internal Medicine, University of Washington, Seattle (Z.D.G., G.N., J.R.C.); Divisions of Cardiology (Z.D.G.) and Pulmonary and Critical Care Medicine (J.R.C.), Harborview Medical Center, University of Washington, Seattle; Harborview Center for Prehospital Emergency Care, University of Washington, Seattle (G.N.); Department of Internal Medicine (B.K.N., C.R.C.), Divisions of Cardiovascular Medicine (B.K.N.), Pulmonary and Critical Care Medicine (C.R.C.), and Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation (B.K.N., C.R.C.), University of Michigan, Ann Arbor; VA Ann Arbor Center for Clinical Management Research, MI (B.K.N.); and Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C.). zgoldber@uw.edu.
authors: Zachary D
authors: ZD
authors: Goldberger
authors: From the Department of Internal Medicine, University of Washington, Seattle (Z.D.G., G.N., J.R.C.); Divisions of Cardiology (Z.D.G.) and Pulmonary and Critical Care Medicine (J.R.C.), Harborview Medical Center, University of Washington, Seattle; Harborview Center for Prehospital Emergency Care, University of Washington, Seattle (G.N.); Department of Internal Medicine (B.K.N., C.R.C.), Divisions of Cardiovascular Medicine (B.K.N.), Pulmonary and Critical Care Medicine (C.R.C.), and Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation (B.K.N., C.R.C.), University of Michigan, Ann Arbor; VA Ann Arbor Center for Clinical Management Research, MI (B.K.N.); and Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C.).
authors: Brahmajee K
authors: BK
authors: Nallamothu
authors: From the Department of Internal Medicine, University of Washington, Seattle (Z.D.G., G.N., J.R.C.); Divisions of Cardiology (Z.D.G.) and Pulmonary and Critical Care Medicine (J.R.C.), Harborview Medical Center, University of Washington, Seattle; Harborview Center for Prehospital Emergency Care, University of Washington, Seattle (G.N.); Department of Internal Medicine (B.K.N., C.R.C.), Divisions of Cardiovascular Medicine (B.K.N.), Pulmonary and Critical Care Medicine (C.R.C.), and Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation (B.K.N., C.R.C.), University of Michigan, Ann Arbor; VA Ann Arbor Center for Clinical Management Research, MI (B.K.N.); and Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C.).
authors: Graham
authors: G
authors: Nichol
authors: From the Department of Internal Medicine, University of Washington, Seattle (Z.D.G., G.N., J.R.C.); Divisions of Cardiology (Z.D.G.) and Pulmonary and Critical Care Medicine (J.R.C.), Harborview Medical Center, University of Washington, Seattle; Harborview Center for Prehospital Emergency Care, University of Washington, Seattle (G.N.); Department of Internal Medicine (B.K.N., C.R.C.), Divisions of Cardiovascular Medicine (B.K.N.), Pulmonary and Critical Care Medicine (C.R.C.), and Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation (B.K.N., C.R.C.), University of Michigan, Ann Arbor; VA Ann Arbor Center for Clinical Management Research, MI (B.K.N.); and Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C.).
authors: Paul S
authors: PS
authors: Chan
authors: From the Department of Internal Medicine, University of Washington, Seattle (Z.D.G., G.N., J.R.C.); Divisions of Cardiology (Z.D.G.) and Pulmonary and Critical Care Medicine (J.R.C.), Harborview Medical Center, University of Washington, Seattle; Harborview Center for Prehospital Emergency Care, University of Washington, Seattle (G.N.); Department of Internal Medicine (B.K.N., C.R.C.), Divisions of Cardiovascular Medicine (B.K.N.), Pulmonary and Critical Care Medicine (C.R.C.), and Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation (B.K.N., C.R.C.), University of Michigan, Ann Arbor; VA Ann Arbor Center for Clinical Management Research, MI (B.K.N.); and Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C.).
authors: J Randall
authors: JR
authors: Curtis
authors: From the Department of Internal Medicine, University of Washington, Seattle (Z.D.G., G.N., J.R.C.); Divisions of Cardiology (Z.D.G.) and Pulmonary and Critical Care Medicine (J.R.C.), Harborview Medical Center, University of Washington, Seattle; Harborview Center for Prehospital Emergency Care, University of Washington, Seattle (G.N.); Department of Internal Medicine (B.K.N., C.R.C.), Divisions of Cardiovascular Medicine (B.K.N.), Pulmonary and Critical Care Medicine (C.R.C.), and Center for Healthcare Outcomes and Policy, Institute for Healthcare Policy and Innovation (B.K.N., C.R.C.), University of Michigan, Ann Arbor; VA Ann Arbor Center for Clinical Management Research, MI (B.K.N.); and Saint Luke's Mid-America Heart Institute, Kansas City, MO (P.S.C.).
authors: Colin R
authors: CR
authors: Cooke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005190:Family; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D018802:Patient-Centered Care; D012151:Resuscitation / Q000523:psychology / Q000706:statistics & numerical data* / Q000639:trends; D016896:Treatment Outcome
keywords: family; patient-centered care; resuscitation