Background: Family engagement in patient care in the cardiac ICU improves the family experience and family outcomes, but its impact on patient outcomes remains unclear. The objective of this study was to explore the relationship between family involvement and patient outcomes using data from the NGAGE trial
METHODS AND RESULTS: The NGAGE trial was a prospective randomized control trial of 88 family members of cardiac ICU and ward patients at the Jewish General Hospital from July 2023 to April 2024. Family members were randomized 1:1 to use the NGAGE tool or to receive usual care. NGAGE facilitated communication and participation in care through the "Engage" function, which allowed family members to request specific care involvement activities such as shared decision-making, education, or direct care activities (e.g., mobility, feeding, grooming). Family data captured included engagement (FAMily Engagement; FAME) and satisfaction (Family Satisfaction-ICU; FS-ICU). The outcomes of interest were the relationship between family engagement and patient outcomes (length of stay, discharge destination, emergency department (ED) visits, and hospital readmission). FAME scores were grouped by quartiles and the highest quartile (Q4; most engaged in care) was compared to the lowest quartile (Q1; least engaged in care) using comparative statistics.
There were 88 patients (mean age 74.6±13.5 years; 35% female) included in the analysis. There were no baseline differences between the lowest and highest FAME quartiles in terms of patient demographics or primary admission diagnoses. Patients with family members in the highest FAME quartile, compared to those in the lowest FAME quartile, had a lower rate of ED visits at 30 days (11.8% vs 41.2%, p=0.050) and 365 days (23.5% vs 70.6%, p=0.005) and hospital readmission at 30 days (5.9% vs. 35.3%, P=0.03). There were no differences in length of hospital stay or discharge destination. Patients whose family members used the NGAGE had lower ED visits at 30 days than those in the usual care group (15.8% vs 32.3%, p=0.04). Higher FS-ICU scores were moderately correlated with lower rates of ED visits and hospital readmissions at 30 and 365 days (range r=-0.22 to -0.28, p< 0.05).
Conclusion: Higher levels of family engagement in patient care were associated with fewer ED visits and hospital readmissions. Family satisfaction was also associated with reduced rates of ED visits and hospital readmission. These findings support the need for further studies to explore whether strategies that increase family involvement in care can improve patient outcomes in the cardiac ICU.
