Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-20T01:44:17.219Z Has data issue: false hasContentIssue false
  • English
  • Français

Implementing family communication pathway in neurosurgical patients in an intensive care unit

Published online by Cambridge University Press:  10 July 2014

Sashikanth Kodali ,
Rebecca Stametz ,
Deserae Clarke ,
Amanda Bengier ,
Haiyan Sun ,
A.J. Layon  and
Jonathan Darer
Sashikanth Kodali*
Affiliation:
Division of Clinical Innovation, Geisinger Health System, Danville, Pennsylvania
Rebecca Stametz
Affiliation:
Division of Clinical Innovation, Geisinger Health System, Danville, Pennsylvania
Deserae Clarke
Affiliation:
Division of Clinical Innovation, Geisinger Health System, Danville, Pennsylvania
Amanda Bengier
Affiliation:
Division of Clinical Innovation, Geisinger Health System, Danville, Pennsylvania
Haiyan Sun
Affiliation:
Center for Health Research, Geisinger Health System, Danville, Pennsylvania
A.J. Layon
Affiliation:
Division of Critical Care, Geisinger Medical Center, Danville, Pennsylvania
Jonathan Darer
Affiliation:
Division of Clinical Innovation, Geisinger Health System, Danville, Pennsylvania
*
Address correspondence and reprint requests to: Sashikanth Kodali, Medical Director, Geisinger Health System, 100 North Academy Avenue, Danville, Pennsylvania 17822. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Family-centered care provides family members with basic needs, which includes information, reassurance, and support. Though national guidelines exist, clinical adoption often lags behind in this area. The Geisinger Health System developed and implemented a program for reliable delivery of best practices related to family communication to patients and families admitted to the intensive care unit (ICU).

Method:

Using a quasiexperimental study design and the 24-item Family Satisfaction in the Intensive Care Unit questionnaire (FSICU–24©) to determine family satisfaction, we measured the impact of a “family communication pathway” facilitated by tools built into the electronic health record on the family satisfaction of neurosurgical patients admitted to the ICU.

Results:

There was no statistically significant difference noted in family satisfaction as determined by FSICU–24 scores, including the Care and Decision Making constructs between the pre- and post-intervention pilot population. The percentage of families reporting the occurrence of a family conference showed only minimal improvement, from 46.5% before to 52.5% following the intervention (p = 0.565). This was mirrored by low numbers of documented family conferences by providers, suggesting poor uptake despite buy-in, use of electronic checklists, and repeated attempts at education.

Significance of results:

This paper reviews the challenges to and implications for implementing national guidelines in the area of family communication in an ICU coupled with the principles of clinical reengineering.

Keywords

Clinical reengineeringIntensive care unit (ICU)Family conferenceMultidisciplinary teamsChecklist for communication
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 4 , August 2015 , pp. 961 - 967
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Azoulay, E., Pochard, F., Kentish-Barnes, N., et al. (2005). Risk of posttraumatic stress symptoms in family members of intensive care unit patients. American Journal of Respiratory Critical Care Medicine, 171(9), 987–994.CrossRefGoogle ScholarPubMed
Baker, R., Wu, A.W., Teno, J.M., et al. (2000). Family satisfaction with end-of-life care in seriously ill hospitalized adults. Journal of the American Geriatrics Society, 48(5 Suppl.), S61.CrossRefGoogle ScholarPubMed
Berry, S.A., Laam, L.A., Wary, A.A., et al. (2011). Proven care perinatal: A model for delivering evidence/guideline-based care for perinatal populations. Joint Commission Journal on Quality and Patient Safety, 37(5), 229–239.Google Scholar
Bright, T.J., Wong, A., Dhurjati, R., et al. (2012). Effect of clinical decision-support systems: A systematic review. Annals of Internal Medicine, 157(1), 29–43.CrossRefGoogle ScholarPubMed
Cypress, B.S. (2011). Family conference in the intensive care unit: A systematic review. Dimensions of Critical Care Nursing, 30(5), 246–255.CrossRefGoogle ScholarPubMed
Fumis, R.R.L., Nishimoto, I.N. & Deheinzelin, D. (2008). Families' interactions with physicians in the intensive care unit: The impact on family's satisfaction. Journal of Critical Care, 23(3), 281–286.CrossRefGoogle ScholarPubMed
Glavan, B.J., Engelberg, R.A., Downey, L., et al. (2008). Using the medical record to evaluate the quality of end-of-life care in the intensive care unit. Critical Care Medicine, 36(4), 1138.CrossRefGoogle Scholar
Hales, B.M. & Pronovost, P.J. (2006). The checklist: A tool for error management and performance improvement. Journal of Critical Care, 21(3), 231–235.CrossRefGoogle ScholarPubMed
Hanson, L.C., Danis, M. & Garrett, J. (1997). What is wrong with end-of-life care? Opinions of bereaved family members. Journal of the American Geriatrics Society, 45(11), 1339–1344.CrossRefGoogle ScholarPubMed
Haynes, A.B., Weiser, T.G., Berry, W.R., et al. (2009). A surgical safety checklist to reduce morbidity and mortality in a global population. The New England Journal of Medicine, 360(5), 491–499.CrossRefGoogle Scholar
Heyland, D.K., Rocker, G.M., Dodek, P.M., et al. (2002). Family satisfaction with care in the intensive care unit: Results of a multiple center study. Critical Care Medicine, 30(7), 1413–1418.CrossRefGoogle ScholarPubMed
Hickey, M. (1990). What are the needs of families of critically ill patients? A review of the literature since 1976. Heart & Lung. 19(4), 401–415.Google ScholarPubMed
Johnson, D., Wilson, M., Cavanaugh, B., et al. (1998) Measuring the ability to meet family needs in an intensive care unit. Critical Care Medicine, 26(2), 266–271.CrossRefGoogle Scholar
Lautrette, A., Darmon, M., Megarbane, B., et al. (2007). A communication strategy and brochure for relatives of patients dying in the ICU. The New England Journal of Medicine, 356(5), 469–478.CrossRefGoogle ScholarPubMed
Lilly, C.M., de Meo, D.L., Sonna, L.A., et al. (2000). An intensive communication intervention for the critically ill. The American Journal of Medicine, 109(6), 469–475.CrossRefGoogle ScholarPubMed
Lilly, C.M., Sonna, L.A., Haley, K.J., et al. (2003). Intensive communication: Four-year follow-up from a clinical practice study. Critical Care Medicine, 31(5), S394–S399.CrossRefGoogle ScholarPubMed
Machlis, G. & Dillman, D.L. (1990). Utilization of foot-in-the-door and social exchange principles to improve response to self-administered questionnaires. Presentation at the Annual Meeting of the American Association of Public Opinion Research in Lancaster, Pennsylvania.Google Scholar
McAdam, J.L., Dracup, K.A., White, D.B., et al. (2010) Symptom experiences of family members of intensive care unit patients at high risk for dying. Critical Care Medicine, 38(4), 1078–1085.CrossRefGoogle ScholarPubMed
Mularski, R.A., Curtis, J.R., Billings, J.A., et al. (2006). Proposed quality measures for palliative care in the critically ill: A consensus from the Robert Wood Johnson foundation critical care workgroup. Critical Care Medicine, 34(11), S404–S411.CrossRefGoogle Scholar
Paulus, R.A., Davis, K. & Steele, G.D. (2008). Continuous innovation in health care: Implications of the Geisinger experience. Health Affairs, 27(5), 1235–1245.CrossRefGoogle ScholarPubMed
Pochard, F., Azoulay, E., Chevret, S., et al. (2001). Symptoms of anxiety and depression in family members of intensive care unit patients: Ethical hypothesis regarding decision-making capacity. Critical Care Medicine, 29(10), 1893–1897.CrossRefGoogle ScholarPubMed
Pochard, F., Darmon, M., Fassier, T., et al. (2005). Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death: A prospective multicenter study. Journal of Critical Care, 20(1), 90–96.CrossRefGoogle ScholarPubMed
Wall, R.J., Engelberg, R.A., Downey, L., et al. (2007). Refinement, scoring, and validation of the Family Satisfaction in the Intensive Care Unit (FS–ICU) Survey. Critical Care Medicine, 35(1), 271–279.CrossRefGoogle ScholarPubMed
Weber, V., Bloom, F., Pierdon, S., et al. (2008). Employing the electronic health record to improve diabetes care: A multifaceted intervention in an integrated delivery system. Journal of General Internal Medicine, 23(4), 379–382.CrossRefGoogle Scholar
Wood, G.C., Chu, X., Manney, C.S., et al. (2012). An electronic health record-enabled obesity database. BMC Medical Informatics and Decision Making, 12(45). doi: 10.1186/1472-6947-12-45.CrossRefGoogle ScholarPubMed