How Pets Can Help Humanize ICUs and Speed Recovery

Credit: Johns Hopkins Critical Care Physical Medicine and Rehabilitation Program

“As critical care medicine is increasingly successful in preventing death, the field is more focused on optimizing patients’ survivorship experience. Through creating humanized ICU environments and implementing nonpharmacologic interventions, patients no longer must wait for hospital discharge before they begin to live again.”

So begins the conclusion of a recently published editorial by researchers from Johns Hopkins University School of Medicine and the Mayo Clinic, who propose that nonpharmacologic interventions such as animal-assisted therapy (AAI) can safely and substantially ease the physical and emotional suffering of ICU patients and enable patients to take a more active role in their recovery.

Studies show that up to 80 percent of ICU patients have delirium—inattention, disorientation, confusion, and sometimes hallucinations—during their stay and that those who are more active and less medicated are at decreased risk for these conditions.

“We were invited to write this editorial because there is a major culture change happening in ICUs across the world,” said rehabilitation psychologist Megan Hosey, PhD, assistant professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine. “The evidence supports keeping patients awake and moving, even though they need lots of intensive medical care.”

Therapy Dogs in the ICU

Dr. Hosey previously worked in the inpatient rehabilitation unit at Johns Hopkins Hospital where AAI was already an established practice. She reported that patients were able to stand longer, perform more functional tasks, and were more engaged in their rehabilitation work when they received visits from therapy dogs. “When I transitioned to the ICU, it seemed like something to explore,” she said.

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Dr. Hosey partnered with experts including Dale Needham, MD, PhD, professor of medicine and physical medicine and rehabilitation at Johns Hopkins University School of Medicine and senior author of the editorial, to adapt the hospital’s protocol to safely bring dogs to ICU patients who could benefit.

“Doctors and nurses have traditionally been of the mindset that if we just give patients the ‘right’ medication, their psychological status will improve,” Dr. Needham said. “In fact, we probably need to give less medicine and rely more on nonpharmaceutical interventions, such as music therapy, relaxation training, and animal-assisted

Credit: Johns Hopkins Critical Care Physical Medicine and Rehabilitation Program

therapy to help improve patients’ psychological status.”

All dogs that participate in AAI programs at Johns Hopkins Hospital are registered through Pet Partners, a program that ensures handlers and pets are up to date on necessary therapy pet training.

To qualify for the Johns Hopkins ICU animal therapy program, patients must be alert enough to engage calmly with a dog, at low risk for infection, and interested in the visits. Ten ICU patients—ranging from their 20s to their 80s—met these criteria and received at least one 20- to 30-minute visit from a therapy dog in 2017.

Positive Feedback, Future Research

While this was only a clinical activity, Dr. Hosey notes that the initial participants gave positive responses about the therapy dog visits. “In the future, we are hoping to measure patients’ ratings of pain, aspects of emotion, and rehabilitation engagement before and after visits,” Dr. Hosey said.

The ICU team at Johns Hoskins plans to continue the AAI program, and Dr. Hosey and her colleagues hope their editorial sparks more hospitals to do the same. “Bringing dogs to the ICU is just one of many nonpharmacological strategies we believe can help these patients endure critical illness and build motivation for recovery,” Dr. Hosey said.