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Crit Care Med. 2018 Apr;46(4):602-611. doi: 10.1097/CCM.0000000000002963.

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

Author information

1
Yale School of Medicine, New Haven, CT.
2
Yale-New Haven Hospital, New Haven, CT.
3
Hill Country Health and Wellness Center, Round Mountain, CA.
4
Yale School of Nursing, New Haven, CT.
5
Fairfield University School of Nursing, Fairfield, CT.
6
Yale College, New Haven, CT.
7
Department of Internal Medicine, Pulmonary, Critical Care and Sleep Medicine Section, VA Connecticut Healthcare System and Yale University School of Medicine, West Haven, CT.
8
Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.
9
Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT.

Abstract

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.

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