When family members of critically ill patients attend rounds in the ICU, enhancing communication and satisfaction may improve healthcare quality, a Canadian study suggests.1 Researchers observed 302 rounds on 210 patients in seven hospitals. They found that family members attended 68 rounds, were present in the ICU but didn’t attend 59 of the rounds, and were not present during the majority of rounds. Some key findings include:

• rounds took about four minutes longer when families were present;

• there were no significant differences in the discussions doctors had about patient prognosis;

• family attendance might improve information-gathering, team dynamics, doctor-patient-family relationship-building, workflow, and shared clinical decision-making.

Family participation during ICU rounds has been recommended for more than a decade.2 “But most of the literature examining outcomes of this practice are forms of satisfaction and experience reports,” says Selena Au, MD, the study’s lead author and a critical care physician at University of Calgary’s department of critical care medicine in Alberta.

Family members and providers share some perspectives on family participation in ICU rounds, but there also is some discordance, found another recent study.3 “It gives us a calling to find out the source of this discrepancy, and find and measure appropriate objective outcomes,” says Au, the study’s lead author.

The researchers surveyed 63 family members and 258 providers. About 38% of providers estimated only moderate family member interest in participating in rounds. Yet 97% of family members expressed high interest. “It’s not a surprise to me that families describe themselves as finding benefit from rounds,” says Au.

Family members and providers both said that listening and sharing information about the patient were appropriate roles for family members. Compared with family members, providers were more likely to perceive family participation as causing stress and confusion. “Role clarity, and its importance to communication, is a recurring theme within many ethical dilemmas that arise,” says Au.

Notably, families saw their role as largely passive. “Proper education on families’ role as an active co-decision-maker during rounds is needed, on both the family and provider fronts,” concludes Au.

REFERENCES

1. Au S, Roze des Ordons AL, Parsons Leigh J, et al. A multicenter observational study of family participation in ICU rounds. Crit Care Med 2018; 46(8):1255-1262.

2. Davidson JE, Powers K, Hedayat KM, et al. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med 2007; 35:605-622.

3. Au SS, Roze des Ordons A, Soo A, et al. Family participation in intensive care unit rounds: Comparing family and provider perspectives. J Crit Care 2017; 38:132-136.

SOURCE

• Selena Au, MD, Department of Critical Care Medicine, University of Calgary, Alberta. Email: selena.au@albertahealthservices.ca.