Long-term persistence of quality improvements for an intensive care unit communication initiative using the VALUE strategy.
OBJECTIVE
Communication in the intensive care unit (ICU) is an important component of quality ICU care. In this report, we evaluate the long-term effects of a quality improvement (QI) initiative, based on the VALUE communication strategy, designed to improve communication with family members of critically ill patients.


METHODS
We implemented a multifaceted intervention to improve communication in the ICU and measured processes of care. Quality improvement components included posted VALUE placards, templated progress note inclusive of communication documentation, and a daily rounding checklist prompt. We evaluated care for all patients cared for by the intensivists during three separate 3 week periods, pre, post, and 3 years following the initial intervention.


RESULTS
Care delivery was assessed in 38 patients and their families in the pre-intervention sample, 27 in the post-intervention period, and 41 in follow-up. Process measures of communication showed improvement across the evaluation periods, for example, daily updates increased from pre 62% to post 76% to current 84% of opportunities.


CONCLUSIONS
Our evaluation of this quality improvement project suggests persistence and continued improvements in the delivery of measured aspects of ICU family communication. Maintenance with point-of-care-tools may account for some of the persistence and continued improvements.
Department of Medicine, Oregon Health and Science University, Portland, OR, USA. Electronic address: Nicholas.Wysham@gmail.com.
Nicholas G
NG
Wysham
Kaiser Permanente, Sunnyside Medical Center, Portland, OR, USA; The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA. Electronic address: Richard.A.Mularski@kpchr.org.
Richard A
RA
Mularski
Kaiser Permanente, Sunnyside Medical Center, Portland, OR, USA. Electronic address: David.M.Schmidt@kp.org.
David M
DM
Schmidt
Kaiser Permanente, Sunnyside Medical Center, Portland, OR, USA. Electronic address: Shirley.C.Nord@kp.org.
Shirley C
SC
Nord
Kaiser Permanente, Sunnyside Medical Center, Portland, OR, USA. Electronic address: Deborah.L.Louis@kp.org.
Deborah L
DL
Louis
The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA. Electronic address: Elizabeth.Shuster@kpchr.org.
Elizabeth
E
Shuster
The University of Washington & Harborview Medical Center, Seattle, WA, USA. Electronic address: JRC@u.washington.edu.
J Randall
JR
Curtis
The Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA. Electronic address: David.M.Mosen@kpchr.org.
David M
DM
Mosen
D000368:Aged; D057189:Checklist; D003142:Communication; D065187:Controlled Before-After Studies; D005190:Family; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D019095:Point-of-Care Systems; D011368:Professional-Family Relations; D058996:Quality Improvement / Q000458:organization & administration*
Communication; Critical care; End-of-life care; Family satisfaction; Outcome and process assessment(health care); Quality of health care