Dedicated Afternoon Rounds for ICU Patients' Families and Family Satisfaction With Care

作者：Weber Urs; Johnson Jennifer; Anderson Nathanial; Knies Andrea K; Nhundu Belinda; Bautista Cynthia; Huang Kevin B; Hamza Muhammad; White Jessica; Coppola Anna; Akgun Kathleen M; Greer David M; Marcolini Evie G; Gilmore Emily J; Petersen Nils H; Timario Nona; Poskus Kelly; Sheth Kevin N; Hwang David Y^*

来源：Critical Care Medicine, 2018, 46(4): 602-611.

DOI：10.1097/CCM.0000000000002963

• communication
• decision making
• family
• intensive care units
• quality improvement

Objective: It was hypothesized that adding dedicated afternoon rounds for patients' families to supplement standard family support would improve overall family satisfaction with care in a neuroscience ICU.
Design: Pre- and postimplementation (pre-I and post-I) design.
Setting: Single academic neuroscience ICU.
Patients: Patients in the neuroscience ICU admitted for longer than 72 hours or made comfort measures only at any point during neuroscience ICU admission.
Intervention: The on-service attending intensivist and a neuroscience ICU nursing leader made bedside visits to families to address concerns during regularly scheduled, advertised times two afternoons each week.
Measurements and Main Results: One family member per patient during the pre-I and post-I periods was recruited to complete the Family Satisfaction in the ICU 24 instrument. Post-I respondents indicated whether they had participated in the afternoon rounds. For primary outcome, the mean pre-I and post-I composite Family Satisfaction in the ICU 24 scores (on a 100-point scale) were compared. A total of 146 pre-I (March 2013 to October 2014; capture rate, 51.6%) and 141 post-I surveys (October 2014 to December 2015; 47.2%) were collected. There was no difference in mean Family Satisfaction in the ICU 24 score between groups (pre-I, 89.2 +/- 11.2; post-I, 87.4 +/- 14.2; p = 0.6). In a secondary analysis, there was also no difference in mean Family Satisfaction in the ICU 24 score between the pre-I respondents and the 39.0% of post-I respondents who participated in family rounds. The mean Family Satisfaction in the ICU 24 score of the post-I respondents who reported no participation trended lower than the mean pre-I score, with fewer respondents in this group reporting complete satisfaction with emotional support (75% vs. 54%; p = 0.002), coordination of care (82% vs. 68%; p = 0.03), and frequency of communication by physicians (60% vs. 43%; p = 0.03).
Conclusions: Dedicated afternoon rounds for families twice a week may not necessarily improve an ICU's overall family satisfaction. Increased dissatisfaction among families who do not or cannot participate is possible.

• 出版日期2018-4