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.

Design: Prospectively collected observational cohort study.

Setting: Nine intensive care units at a tertiary care university hospital in the United States.

Participants: 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.

Intervention: None.

Measurements and main 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).

Conclusion: 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.

Figure 1

Predicting and explaining dissatisfaction with intensive care unit (ICU) care. One point is assigned for each factor identified in Table 1, and includes only factors ascertainable at ICU arrival.