Communication in critical care: family rounds in the intensive care unit.
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.
Jacobowski
Natalie L
NL
Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232-8300, USA. natalie.jacobowski@vanderbilt.edu
Girard
Timothy D
TD
Mulder
John A
JA
Ely
E Wesley
EW
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
Intensive Care Med. 2005 May;31(5):668-73
15803296
Am J Respir Crit Care Med. 2008 Aug 1;178(3):269-75
18480429
Am Surg. 2005 Oct;71(10):886-91
16468543
Crit Care Med. 2002 Jul;30(7):1413-8
12130954
Am J Respir Crit Care Med. 2005 Apr 15;171(8):844-9
15640361
Crit Care Med. 2004 Nov;32(11):2323-8
15640649
J Crit Care. 2005 Mar;20(1):90-6
16015522
Chest. 2008 Mar;133(3):704-12
18198256
Crit Care Med. 2004 Sep;32(9):1832-8
15343009
Pediatrics. 2007 Apr;119(4):829-32
17403858
J Crit Care. 2002 Sep;17(3):147-60
12297990
Intensive Care Med. 2003 Sep;29(9):1498-504
12856124
Respir Care. 2008 Apr;53(4):480-7
18364061
Crit Care Med. 2007 Feb;35(2):442-8
17205000
J Gen Intern Med. 1989 Jul-Aug;4(4):284-7
2760696
Am J Respir Crit Care Med. 2002 Feb 15;165(4):438-42
11850333
Crit Care Med. 2000 Aug;28(8):3044-9
10966293
Curr Opin Crit Care. 2003 Dec;9(6):545-50
14639077
Crit Care Med. 2006 Nov;34(11 Suppl):S380-7
17057602
Am J Respir Crit Care Med. 2001 Jan;163(1):135-9
11208638
Am J Crit Care. 2005 Sep;14(5):395-403
16120891
Surg Clin North Am. 2005 Apr;85(2):303-13
15833473
Crit Care Med. 2007 Jan;35(1):271-9
17133189
Am J Respir Crit Care Med. 2008 Oct 15;178(8):798-804
18703787
Intensive Care Med. 2003 Jan;29(1):75-82
12528026
BMJ. 1998 Apr 18;316(7139):1236-8
9553006
Chest. 2005 May;127(5):1775-83
15888858
JAMA. 1999 Aug 11;282(6):583-9
10450723
N Engl J Med. 2007 Feb 1;356(5):469-78
17267907
Chest. 2005 Sep;128(3):1728-35
16162781
Chest. 2008 Oct;134(4):835-843
18842916
Chest. 2008 Jul;134(1):109-16
18347204
J Pediatr. 1988 Mar;112(3):378-84
3346775
Acad Med. 2008 Mar;83(3):292-7
18316881
Health Serv Res. 2009 Aug;44(4):1326-44
19490162
Epidemiology. 1990 Jan;1(1):43-6
2081237
Crit Care Med. 2007 Feb;35(2):422-9
17205001
Chest. 2003 Jul;124(1):392-7
12853551
N Engl J Med. 1997 Apr 17;336(16):1150-5
9099660
Crit Care Med. 2007 Feb;35(2):605-22
17205007
J Trauma Nurs. 2003 Oct-Dec;10(4):93-101
16502828
Am J Respir Crit Care Med. 2005 Apr 15;171(8):803-4
15817804
Intensive Care Med. 2005 Sep;31(9):1215-21
16041519