title: Implementing family communication pathway in neurosurgical patients in an intensive care unit.
abstract: OBJECTIVE
  Family-centered care provides family members with basic needs, which includes information, reassurance, and support. Though national guidelines exist, clinical adoption often lags behind in this area. The Geisinger Health System developed and implemented a program for reliable delivery of best practices related to family communication to patients and families admitted to the intensive care unit (ICU).
  
  
  METHODS
  Using a quasiexperimental study design and the 24-item Family Satisfaction in the Intensive Care Unit questionnaire (FSICU-24©) to determine family satisfaction, we measured the impact of a "family communication pathway" facilitated by tools built into the electronic health record on the family satisfaction of neurosurgical patients admitted to the ICU.
  
  
  RESULTS
  There was no statistically significant difference noted in family satisfaction as determined by FSICU-24 scores, including the Care and Decision Making constructs between the pre- and post-intervention pilot population. The percentage of families reporting the occurrence of a family conference showed only minimal improvement, from 46.5% before to 52.5% following the intervention (p = 0.565). This was mirrored by low numbers of documented family conferences by providers, suggesting poor uptake despite buy-in, use of electronic checklists, and repeated attempts at education.
  
  
  CONCLUSIONS
  This paper reviews the challenges to and implications for implementing national guidelines in the area of family communication in an ICU coupled with the principles of clinical reengineering.
authors.affiliation: Division of Clinical Innovation,Geisinger Health System,Danville,Pennsylvania.
authors.forename: Sashikanth
authors.initials: S
authors.lastname: Kodali
authors.affiliation: Division of Clinical Innovation,Geisinger Health System,Danville,Pennsylvania.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Stametz
authors.affiliation: Division of Clinical Innovation,Geisinger Health System,Danville,Pennsylvania.
authors.forename: Deserae
authors.initials: D
authors.lastname: Clarke
authors.affiliation: Division of Clinical Innovation,Geisinger Health System,Danville,Pennsylvania.
authors.forename: Amanda
authors.initials: A
authors.lastname: Bengier
authors.affiliation: Center for Health Research,Geisinger Health System,Danville,Pennsylvania.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Sun
authors.affiliation: Division of Critical Care,Geisinger Medical Center,Danville,Pennsylvania.
authors.forename: A J
authors.initials: AJ
authors.lastname: Layon
authors.affiliation: Division of Clinical Innovation,Geisinger Health System,Danville,Pennsylvania.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Darer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057189:Checklist; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000451:nursing*; D011368:Professional-Family Relations; D011795:Surveys and Questionnaires
keywords: Checklist for communication; Clinical reengineering; Family conference; Intensive care unit (ICU); Multidisciplinary teams