title: Communication in critical care: family rounds in the intensive care unit.
abstract: BACKGROUND
  Communication with family members of patients in intensive care units is challenging and fraught with dissatisfaction.
  
  
  OBJECTIVE
  We hypothesized that family attendance at structured interdisciplinary family rounds would enhance communication and facilitate end-of-life planning (when appropriate).
  
  
  METHODS
  The study was conducted in the 26-bed medical intensive care unit of a tertiary care, academic medical center from April through October 2006. Starting in July 2006, families were invited to attend daily interdisciplinary rounds where the medical team discussed the plan for care. Family members were surveyed at least 1 month after the patient's stay in the unit, completing the validated "Family Satisfaction in the ICU" tool before and after implementation of family rounds.
  
  
  RESULTS
  Of 227 patients enrolled, 187 patients survived and 40 died. Among families of survivors, participation in family rounds was associated with higher family satisfaction regarding frequency of communication with physicians (P = .004) and support during decision making (P = .005). Participation decreased satisfaction regarding time for decision making (P = .02). Overall satisfaction scores did not differ between families who attended rounds and families who did not. For families of patients who died, participation in family rounds did not significantly change satisfaction.
  
  
  CONCLUSIONS
  In the context of this pilot study of family rounds, certain elements of satisfaction were improved, but not overall satisfaction. The findings indicate that structured interdisciplinary family rounds can improve some families' satisfaction, whereas some families feel rushed to make decisions. More work is needed to optimize communication between staff in the intensive care unit and patients' families, families' comprehension, and the effects on staff workload.
authors.affiliation: Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8300, USA. natalie.jacobowski@vanderbilt.edu
authors.forename: Natalie L
authors.initials: NL
authors.lastname: Jacobowski
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Girard
authors.forename: John A
authors.initials: JA
authors.lastname: Mulder
authors.forename: E Wesley
authors.initials: EW
authors.lastname: Ely
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D022143:Family Nursing / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D017060:Patient Satisfaction; D010865:Pilot Projects; D056164:Teaching Rounds / Q000379:methods*; D013727:Terminal Care
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