Implementation of a structured communication tool improves family satisfaction and expectations in the intensive care unit

This paper by Sviri and colleagues was published in the Journal of Critical Care online during January 2019.
Background:  Intensive care unit (ICU) physicians should provide relatives of critically ill patients with appropriate and clear information, regarding prognosis, treatment options and expectations.
Objectives:  To assess whether a structured communication tool improves satisfaction with care and engenders realistic expectations among relatives of critically ill patients.
Study design:  A controlled, pre-post intervention design was implemented in the General and Medical ICUs in the Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Methods:  Forty relatives of patients who received usual communication from the medical staff (control group) were interviewed. We then implemented a structured communication tool and another forty family members were interviewed (intervention group). The ICU physicians who participated in the family meeting were also interviewed.
Results:  Satisfaction in the intervention group was higher regarding ease of obtaining the information (90% vs 70%, p = .025) and the consistency of information provided (92.5% vs 77.5%, p = .057). There was better correlation between physicians’ and relatives’ expectations in the intervention group regarding hospital survival (Kappa 0.322 vs 0.054, p = .01). Physicians predicted more accurately patients’ actual hospital survival.
Conclusions:  A structured communication tool was associated with improved family satisfaction with communication and expectations regarding hospital survival. Further research is required to evaluate this promising intervention.
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Physicians’ Interactions with Peers: Empathic Accuracy during Shift Handovers on Intensive-Care Units

This research by Klumb, Wicki and Rauers was published in the October 2018 issue of “Applied psychology health and well-being”.
Background:  We investigated how accurately physicians judge colleagues’ states during shift handovers on intensive-care units, the role of physician characteristics, and how accuracy is related to handover partners’ satisfaction.
Methods:  Using mobile phones, we assessed momentary judgements during N = 272 shift handovers by 36 physicians of five Swiss clinics. Physicians rated their own and their partner’s affective states. We calculated the covariation of the perceiver’s judgements of the partner’s affect with the partner’s self-reported affect and the perceiver’s own self-reported affect. We then examined the moderation of these covariations by physicians’ roles and experience.
Results:  Overall, resident physicians were moderately successful in taking their counterparts’ perspective: Perceiver’s ratings of partner’s affect and the latter’s self-ratings were significantly related. Associations between perceivers’ ratings of their own and their partner’s affect were also evident. None of the effects varied as a function of physicians’ roles. There was an unexpected effect of job experience; physicians with more experience were more likely to project their own affect into the rating of partner’s affect. Physicians’ accuracy in judging the partner’s tense arousal was related to the partner’s satisfaction with the social interaction. This effect may have been mainly driven by instances in which low tension was accurately judged, however.
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Interruptions During Senior Nurse Handover in the Intensive Care Unit: A Quality Improvement Study

This article by Spooner and colleagues was published in June 2018 issue of the Journal of Nursing Care Quality.
Background:  Interruptions during handover may compromise continuity of care and patient safety.
Local Problem:  Interruptions occur frequently during handovers in the intensive care unit.
Methods:  A quality improvement study was undertaken to improve nursing team leader handover processes. The frequency, source, and reason interruptions occurred were recorded before and after a handover intervention.
Interventions:  The intervention involved relocating handover from the desk to bedside and using a printed version of an evidence-based electronic minimum data set. These strategies were supported by education, champions, reminders, and audit and feedback.
Results:  Forty handovers were audio taped before, and 49 were observed 3 months following the intervention. Sixty-four interruptions occurred before and 52 after the intervention, but this difference was not statistically significant. Team leaders were frequently interrupted by nurses discussing personal or work-specific matters before and after the intervention.
Conclusions:  Further work is required to reduce interruptions that do not benefit patient care.
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An observational study of patient handover communications among nurses on an oncology critical care unit.

This article by Milesky and colleagues was published in the December issue of Contemporary Nurse.
Aim/Objectives: The purpose of this quality improvement project was to evaluate the feasibility and utilization of evidence-based recommendations for nurse-to-nurse shift handover on an oncology critical care unit.
Background:  Breakdown in communication is the most common cause of medical errors in hospitals.
Design:  Observational study.
Methods:  Nurses were provided education that integrated evidence-based recommendations for handover of care. Nursing shift report was observed for one month in 2015 and for one month in 2016. Results were evaluated for inclusion of twenty-four evidence-based essential elements for handover communication which included measures of total completeness and interruptions during the handover process.
Results:  Total completeness of handover increased with 86.64% (N=38) in 2015 and 88.68% (N=35) in 2016. Although, the increases were not statistically significant, interruptions during handover were positively correlated with length of handover r=0.587 (n=18, p=0.010), thus confirming need for structured, more effective handover methods.
Conclusions:  Providing education, mentoring and real-time feedback to motivated staff may lead to improvements in handover communication methods, yielding positive patient outcomes. Impact Statement Evidence-based, standardized handover communications among nurses can improve patient safety and prevent harm.
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A Multifaceted Intervention to Improve Outcomes in Intensive Care

This study examines the effectiveness of a patient-centered care and engagement program in the medical ICU | Critical Care Medicine

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Interventions: Structured patient-centered care and engagement training program and web-based technology including ICU safety checklist, tools to develop shared care plan, and messaging platform. Patient and care partner access to online portal to view health information, participate in the care plan, and communicate with providers.

Measurements and Main Results: Primary outcome was aggregate adverse event rate. Secondary outcomes included patient and care partner satisfaction, care plan concordance, and resource utilization. We included 2,105 patient admissions, (1,030 baseline and 1,075 during intervention periods). The aggregate rate of adverse events fell 29%, from 59.0 per 1,000 patient days (95% CI, 51.8-67.2) to 41.9 per 1,000 patient days (95% CI, 36.3-48.3; p < 0.001), during the intervention period. Satisfaction improved markedly from an overall hospital rating of 71.8 (95% CI, 61.1-82.6) to 93.3 (95% CI, 88.2-98.4; p < 0.001) for patients and from 84.3 (95% CI, 81.3-87.3) to 90.0 (95% CI, 88.1-91.9; p < 0.001) for care partners. No change in care plan concordance or resource utilization.

Conclusions: Implementation of a structured team communication and patient engagement program in the ICU was associated with a reduction in adverse events and improved patient and care partner satisfaction.

Full reference: Dykes, P. et al. (2017) Prospective Evaluation of a Multifaceted Intervention to Improve Outcomes in Intensive Care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study. Critical Care Medicine. Published online: 3rd May 2017

Patient- and Family-Centered Care: First Steps on a Long Journey

Sevransky, J. (2017) Critical Care Medicine. 45(5) pp. 757–758

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ICUs are among the most intimidating locations in the hospital for patients and families. Some machines are connected to the surface. Others invade the substance of the body. Life-sustaining devices and their connections often impair communication and performance of the activities of daily life. Even professionals-turned patients have difficulties communicating effectively when on the other side of the stethoscope (1) in an ICU.

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A Clinicians Guide to Privacy and Communication in the ICU

Francis, L. et al. (2017) Critical Care Medicine. 45 (3) pp. 480–485

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Objective: To review the legal issues concerning family members’ access to information when patients are in the ICU.

Conclusions: The Health Insurance Portability and Accountability Act and related laws should not be viewed as barriers to clinicians sharing information with ICU patients and their loved ones. Generally, under Health Insurance Portability and Accountability Act, personal representatives have the same authority to receive information that patients would otherwise have. Persons involved in the patient’s care also may be given information relevant to the episode of care unless the patient objects. ICUs should develop policies for handling the issues we identify about such information sharing, including policies for responding to telephone inquiries and methods for giving patients the opportunity to object to sharing information with individuals involved in their care. ICU clinicians also should be knowledgeable of their state’s laws about how to identify patients’ personal representatives and the authority of those representatives. Finally, ICU clinicians should be aware of any special restrictions their state places on medical information. In aggregate, these strategies should help ICU managers and clinicians facilitate robust communication with patients and their loved ones.

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