PURPOSE:Communication in the ICU is important across multiple domains of care but deficiency and variability exist in practice. We used the VALUE communication tool in a quality innovation (QI) project in an 18-bed ICU.
METHODS:VALUE mnemonic: Value and appreciate what is said Acknowledge members’ emotions Listen Understand who the patient is as a person Elicit questions. We refined the VALUE communication intervention, deployed laminated reminder placards and pocket-cards, and used concomitant point-of-care clinical reminder (daily rounding prompt). We measured impact on processes and outcomes in pre-post design. The main outcome measure was the Family Satisfaction in the Intensive Care Unit (FS-ICU) mailed to families 4–8 weeks after ICU admission. Comparisons used t-tests and Chi-Square; performance scores used Wilcoxon rank sums.
RESULTS:We evaluated 38 patients-families pre-innovation and 27 post; no significant differences existed between groups (APACHE II 16.1 ± 7.4 pre, 15.8 ± 6.5 post; ICU LOS 7.3 ± 11.3 pre, 8.3 ± 9.7 post). The number of family conferences increased from 3 pre-intervention to 26 in post-intervention period. Overall there was an 18% absolute increase in the number of ICU patients whose care included family conferences. An independent implicit rating of how well the clinician performed on the 5 aspects of VALUE remained favorable (7.8 pre to 8.1 points of 10 post with slight increase in domain of understanding patient as a person. The FS-ICU improved 10% overall (pre 79.1 median, 25–75IQR [60.0, 94.0] to post 88.0 [79.2, 94.8] of 100 best satisfaction score). Families reported higher levels of satisfaction with care (19% increase), satisfaction with decision-making (8% increase), and satisfaction with the ICU experience (14% increase). FS-ICU response rate 39%; due to small n, none of the changes attained alpha < 0.05.
CONCLUSION:We were successful in improving both processes of ICU communication and family reported satisfaction measured by the FS-ICU.
CLINICAL IMPLICATIONS:VALUE communication strategy with daily rounding prompt appears effective for improving ICU patient care and family satisfaction.
DISCLOSURE:Richard Mularski, No Financial Disclosure Information; No Product/Research Disclosure Information