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.

Objectives: 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.

Figure 1. Flowchart of family member interviews: Baseline Phase

This flowchart demonstrates the numbers of surveys conducted during the baseline phase, with detailed listing of whether or not the family was associated with an ICU patient who had been discharged alive or dead (designated as end-of-life, EOL).

Figure 2. Flowchart of family member interviews: Intervention Phase

This flowchart demonstrates the numbers of surveys conducted after incipience of Family Rounds, with detailed listing of whether or not the family was associated with an ICU patient who had been discharged alive or dead (designated as end-of-life, EOL) and attendance of family rounds.