Many hospitals limit access.

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http://www.latimes.com/features/health/la-he-access21jul21,1,880820.story

Alone in the ER

People receiving invasive or lifesaving treatment often want loved ones present, but many hospitals limit access.

By Jane E. Allen

Times Staff Writer

July 21, 2003

An emergency room or intensive care unit is the last place many people want to be alone.

A life-threatening illness or injury is frightening enough; having a loved one present can make the ordeal less terrifying. It can also ensure better care because relatives, partners or close friends frequently provide crucial information and a health history to doctors and nurses.

Often, however, patients are on their own.

Of nearly 1,000 emergency and critical-care nurses who responded to a national survey, 29% said they worked in units that prohibited relatives from being present during cardiopulmonary resuscitation. Similarly, 25% said their units barred family members during invasive procedures, such as a spinal tap or insertion of a breathing tube.

Despite a decade of efforts by patients' rights advocates and nursing groups to give loved ones the option of remaining during such treatments, just 5% of nurses said their institutions had written policies supporting family access. Only about half the nurses surveyed said their units had informal policies permitting them to let loved ones stay.

The survey, co-sponsored by the American Assn. of Critical-Care Nurses and the Emergency Nurses Assn., was mailed to 1,500 randomly selected members of each group in 2001. Results appeared in the May 2003 issue of the American Journal of Critical Care and the June 2003 issue of the Journal of Emergency Nursing. The emergency nurses' group has long advocated giving families the option of being present during emergency treatment, and the American Heart Assn. recommends offering that option during CPR and emergency heart procedures.

"Three-quarters or more of the American public wants to be there with their loved one during CPR and invasive procedures," said study coauthor Dorrie Fontaine, president of the American Assn. of Critical-Care Nurses. Still, allowing nonmedical personnel into overtaxed emergency rooms remains controversial. In part, that's because many emergency departments are stretched thin and doctors fear that an unaccompanied family member could become emotionally overwrought and interfere with treatment

"There are some people who are not used to the sight of what we do," said Dr. Stephen Epstein, an emergency physician at Beth Israel Deaconess Medical Center in Boston. They might faint" or even interrupt the procedure, he said. "We have to balance the safety of a family member or loved one coming in against the desire to be there."

Epstein, a spokesman for the American College of Emergency Physicians, said the solution is "to have additional nursing staff who can stay" with loved ones and explain what's happening. But a severe nursing shortage means there often aren't enough professionals on hand to do this properly, he added.

A small but increasing number of hospitals do allow a loved one-whether a relative, domestic partner, lover, friend or caregiver-to be there to lend emotional support, said Susan Olsen-Nakada, chief nurse officer at Sharp Coronado Hospital in San Diego. Sharp Coronado is among more than 70 medical centers in the Planetree Alliance, a coalition of hospitals that offer unrestricted visitation as part of an emphasis on patient-centered care. "The general rule is to allow anybody of importance to the patient to stay."

Changing demographics and changing definitions of family make the need for such policies all the greater, say nurses' groups and patients' advocates.

As the population ages, more elderly patients are outliving their relatives. They depend on friends, neighbors and other caregivers to function as their next of kin, especially when faced with medical crises.

Gays and lesbians often want to be accompanied by partners or close friends who constitute their families as well. Years of lobbying in Congress and in corporate boardrooms have brought increased recognition for their domestic partnerships, but their gains don't always guarantee equal access in emergencies.

"There is more sensitivity in hospitals today around different family constellations," said Kim I. Mills, education director of the Human Rights Campaign in Washington, D.C., the nation's largest gay and lesbian advocacy group. But even if hospitals are accepting, disapproving relatives sometimes bar partners during emergency procedures. Fontaine, the associate dean for academic programs at the UC San Francisco School of Nursing, said the bottom line should be heeding the patient's wishes: "If the patient would want somebody there, that's what should drive all of it."

As for the accompanying loved one, they cope better with the death of a patient if they're allowed at the bedside in those last moments when doctors are performing life-saving techniques, studies have shown.

Charles B. Inlander, president of the People's Medical Society in Allentown, Pa., says no laws explicitly exclude loved ones from the emergency room. They have the right to be there if that's the patient's wish and if they don't interfere with delivery of medical care.

"If the patient makes it known 'I want my lover with me, my partner with me, my wife with me, my neighbor with me,' that's as good as having a legal right," Inlander said. If the patient is unconscious, it's up to loved ones to be assertive without alienating medical staff.

Hospital policies excluding such people "are not laws. Those are little rules they make up for their institution."