Allowing E. Iowa families in emergency rooms isn't clear-cut decision

Each year thousands of Iowans rush to the emergency room in need of care. And doctors say that nine times out of 10, patients arrive with a gathering of concerned family or friends.

Once banned from the treatment area for fear they might hinder care, today family members more often than not are allowed to be with their loved ones during the traumatic experience.

“We don't have a set policy,” said Dr. Stephen Schekel, medical director of the Emergency Care Unit at Mercy Iowa City, “but our unwritten policy is that family members are certainly allowed to come back into rooms with patients.”

Sandi McIntosh, director of Emergency Services at St. Luke's Hospital in Cedar Rapids, said there are circumstance when allowing relatives in the emergency room might be inappropriate.

McIntosh gave examples of domestic violence situations in which the relative might be responsible for the patient's injuries or in cases where the patient might be in such bad condition that the family couldn't handle seeing them.

“There is no black or white answer,” said McIntosh. “It depends what patients come in with.”

A family's experiences

For one family in southeast Iowa, participating in the emergency room meant relieving their worst fears instead of deepening them.

John Loin, 55, owner of Partner Construction in Fairfield, was repairing the foundation of a house with his son Noah early in the morning on July 3, 2010. It was a wet summer and Loin said he was rushing to make progress before it started to rain when his foot slipped on the lever of his excavator, pinning him between the machine and a concrete wall.

“I remember not knowing what to do,” said Loin. “I was in shock.”

Noah Loin, 26, pried the machine off his father, put him in his truck and drove him to the Jefferson County Health Center emergency room in Fairfield.

The nurses allowed Noah and his mom into the examination room with Loin.

“I would have felt awful if they hadn't let me back with him,” Noah said. “I was worried that I was watching my dad die.”

Instead, the staff reassured the family and kept them present while they ran tests and X-rays. They quickly discovered that Loin's shoulder blade was broken, but that his organs were unharmed.

Loin's wife Jodi, a former nurse practitioner, was able to discuss the treatment plan and pain control with staff. Loin said including his family helped keep them calm.

The family had the opposite experience later that summer when Noah Loin suffered a head injury while surfing in New Jersey.

He was taken to an emergency room in an ambulance and waited hours before he saw the family members who were vacationing with him. His mom asked to see him, but wasn't allowed.

“The nurses said it was too crowded,” Noah Loin said.

‘This is Iowa'

Dr. Michael Miller, clinical medical director of the emergency room at University of Iowa Hospitals and Clinics in Iowa City, said it is common for bigger cities to limit family visits due to packed emergency rooms.

“But this is Iowa, so we let people be with their family,” said Miller.

Miller agreed with McIntosh that it isn't always a good idea, though.

For example, he said, family members may be asked to wait while doctors run tests when trauma patients come in from an ambulance or helicopter.

“In those situations the patient is unstable ... we are performing life saving-efforts,” said Miller.

UI nursing student Olivia Croskey, who spent three months doing clinical rotations in the emergency room, said she's seen family members be both a help and a hindrance in the ER. She said they can offer emotional support, help advocate for pain control, assist in the treatment plan and provide medical staff with a patient's background.

But she said they also tend to speak for the patient, fight, and sometimes persuade a patient to do a procedure if they think it will save their family member's life.

Croskey said that regardless of the pros and cons of family presence, she believes patients should make that call.

“I think it should be part of training,” said Croskey. “There's a movement toward patient-centered care - their needs and values should be the number one priority.”

Miller said new staff at UI Hospitals are taught how to receive visitors.

“During orientation these issues are discussed, and it is then left to the discretion of the physician what is the safest and in the best interest of the patient given each situation,” Miller said.

Then there's the question of what to do when a patient in full cardiac arrest is being resuscitated.

McIntosh said staff at St. Luke's has come to a clear enough consensus to write into hospital policy that families are allowed in the room during such circumstances.

The practice supports the right of family members to be present in what might be the patient's last moments, she said, and is endorsed by the Emergency Nurses Association and the American Heart Association.

Miller said there is general agreement at UI Hospitals to allow families in during resuscitation.

“Our physicians ... all feel the presence of the family is important,” he said.