title: Predictors and correlates of dissatisfaction with intensive care.
abstract: OBJECTIVE
  Dissatisfaction is an important threat to high-quality care. The aim of this study was to identify factors independently associated with dissatisfaction with critical care.
  
  
  METHODS
  Prospectively collected observational cohort study.
  
  
  METHODS
  Nine intensive care units at a tertiary care university hospital in the United States.
  
  
  METHODS
  Four hundred forty-nine family members of adult intensive care unit patients who completed the Family Satisfaction with Care in the Intensive Care Unit instrument.
  
  
  METHODS
  None.
  
  
  RESULTS
  Four family-and patient-related factors ascertainable at intensive care unit admission independently predicted low overall satisfaction: living in the same city as the hospital, disagreement within the family regarding care, having a cardiac comorbidity but being hospitalized in a noncardiac-care intensive care unit, and living in a different household than the patient. When three or more risk factors were present, 63% (95% confidence interval 48%-78%) of families were dissatisfied. Among factors ascertained at the end of the intensive care unit stay, dissatisfaction with six items was independently associated with overall dissatisfaction: 1) perceived competence of nurses (odds ratio for dissatisfaction=5.9, 95% confidence interval 2.3-15.2); 2) concern and caring by intensive care unit staff (odds ratio 5.0, 95% confidence interval 1.9-12.6); 3) completeness of information (odds ratio 4.4, 95% confidence interval 2.4-8.1); 4) dissatisfaction with the decision-making process (odds ratio 3.0, 95% confidence interval 1.6- 5.6); 5) atmosphere of the intensive care unit (odds ratio 2.6, 95% confidence interval 1.4-4.8); and 6) atmosphere of the waiting room (odds ratio 2.7, 95% confidence interval 1.2-6.0).
  
  
  CONCLUSIONS
  Specific factors ascertainable at intensive care unit admission identify families at high risk of dissatisfaction with care. Other discrete aspects of the patient/family experience that develop during the intensive care unit stay are also strongly associated with dissatisfaction with the critical care experience. These results may provide insight into the design of future evidence-based strategies to improve satisfaction with the intensive care unit experience.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and the Silverman Institute for Healthcare Quality and Safety, Beth Israel Deaconess Medical Center, Children's Hospital Boston, and Harvard Medical School, Boston, MA, USA. hunzikers@post.harvard.edu
authors.forename: Sabina
authors.initials: S
authors.lastname: Hunziker
authors.forename: Wendy
authors.initials: W
authors.lastname: McHugh
authors.forename: Barbara
authors.initials: B
authors.lastname: Sarnoff-Lee
authors.forename: Sabrina
authors.initials: S
authors.lastname: Cannistraro
authors.forename: Long
authors.initials: L
authors.lastname: Ngo
authors.forename: Edward
authors.initials: E
authors.lastname: Marcantonio
authors.forename: Michael D
authors.initials: MD
authors.lastname: Howell
mesh_terms: D000368:Aged; D003422:Critical Care / Q000523:psychology / Q000592:standards*; D003657:Decision Making; D005190:Family / Q000523:psychology; D005195:Family Relations; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012307:Risk Factors