PURPOSE: To identify barriers to communication between the providers and the patient families in a semi-open surgical intensive care unit (ICU); and to identify possible areas of intervention.
METHODS: Interviews with 50 ICU patient families following a formal family meeting using 25 open ended questions. Both quantitative and qualitative analyses were performed on the data.
RESULTS: Despite reported 98% satisfaction with medical care, qualitative analysis revealed a 40% communication failure rate between the families and the health care team. Though 74% of families thought that they received adequate medical information, only 35% reported satisfaction with the information on the current status of their loved one. The families frequently had a ‘Yes, but…’ attached to their responses. Families reported to have to lead the conversation, and be aggressive in order to make the communication clearer. The nurses and social workers, not the physicians, were reported to effectively communicate in layman’s terms. Recurrent themes included lack of a single contact person for information dissemination, failure to inform about minor procedures (ie insertion of central lines, bronchoscopy etc.), failing to provide a realistic timeline on patient’s condition, not holding a family meeting early on in the patient’s ICU stay, and fragmented information dissemination. Satisfaction about the ancillary services provided was poor.
CONCLUSION: The quantitative analysis of communication with the families can be misleading. Qualitative analysis shows that despite evidence that improvement is needed in communication between the care providers and families, the barriers are still not recognized and acknowledged by the physicians. This problem is magnified in semi-open ICUs as multiple providers are involved in patient care. The challenge of identification of barriers, interventions and outcomes improvement still lies ahead.
CLINICAL IMPLICATIONS: Communication failures are frequently identified in malpractice cases. Without effective interventions to improve this area, surrogate decision-making leading to a satisfactory outcome can be a cumbersome process in the ICU.
DISCLOSURE: Namrata Patil, None.