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Family Rounds in the ICU: A Means to Improve Family Satisfaction?
Abstract & Commentary
By Leslie A. Hoffman, RN, PhD, Department of Acute/Tertiary Care, School of Nursing, University of Pittsburgh. Dr. Hoffman reports no financial relationship to this field of study.This article originally appeared in the May 2011 issue of Critical Care Alert. It was edited by David J. Pierson, MD, and was peer reviewed by William Thompson, MD. Dr. Pierson is Professor, Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, and Dr. Thompson is Associate Professor of Medicine, University of Washington, Seattle. Drs. Pierson and Thompson report no financial relationships relevant to this field of study.
Synopsis: Involving family members in ICU rounds improved satisfaction in some areas, such as physician communication and decision-making support, but failed to improve overall family satisfaction.
Source: Jacobowski NL, et al. Communication in critical care: Family rounds in the intensive care unit. Am J Crit Care 2010;19:421-430.
Communicating with family members in a manner that ensures satisfaction with the information received, assists in reducing distress, and supports decision making is challenging. This study was conducted to determine if incorporating family input into daily rounds would enhance communication and facilitate end-of-life decision making, when appropriate. Subjects were family members of 227 patients admitted to a medical ICU in an academic medical center. Family rounds were added to daily rounds using two additional steps. After the usual format, which incorporated updates from nurses, the intern, residents, fellows, and teaching, the attending physician provided a progress summary for family members in lay language and the opportunity to ask questions. Up to two family members were included. If questions were extensive, members were invited to meet with the team after rounds. Family members were surveyed by telephone 1 month after discharge (survivors), or 3-5 months after discharge (if the patient was deceased) using a validated questionnaire. Family members of patients admitted before the implementation of family rounds served as the comparison group.
For survivors, participation in family rounds increased satisfaction regarding frequency of communication with physicians (P = 0.004) and support during decision making (P = 0.005). However, there was no improvement in overall satisfaction scores. For families of non-survivors, there was no improvement in overall satisfaction ratings or any item.
There is broad consensus that state-of-the-art care in the ICU includes support for family members as they attempt to cope with stress inherent in the ICU experience. The challenge is finding a means to provide comprehensive, timely, ongoing support that is sufficient to meet family needs. The investigators conceived the approach tested in this study incorporating family input into daily interdisciplinary rounds as a means to ensure that families would receive a daily update, have the opportunity to ask questions, and receive this information in a consistent manner from one individual the attending physician. The intervention also included the opportunity for more extended discussions at another time if all questions could not be answered during rounds. The process was viewed as an efficient means of insuring that updates were provided on a daily basis and goals were shared when multiple members of the management team were together.
As with many interventions designed to improve family satisfaction, this approach met with uneven success. There was no change in ratings of satisfaction for families of patients who died during the ICU admission. For survivors, some areas improved, such as frequency of communication with physicians, and support for decision making. However, neither group rated "overall satisfaction" higher as a result of the intervention. Searching for explanations, the investigators cited several reasons: high initial satisfaction ratings (leaving limited room for improvement), few items targeted at issues likely to be affected by family rounds, and work/life challenges that prevented many family members from participating. While study findings did not prove the intervention to be a resounding success, the process tested does provide an efficient means to ensure daily family updates and should, therefore, be considered as a means to support families during this experience.