Critical illness has a significant effect on both patients and their families.

What can we do to improve support and the overall experience for relatives of our patients on ICU? 

Duncan Chambler

Survival rates for ICU are around 75%, varying with many factors, but this does mean that in 25% of our workload, it is only the relatives that ultimately hold the memory of our work. In terms of numbers, there are many relatives affected around the illness of just one patient. Despite this, rightly or wrongly, the time we spend talking to relatives as clinicians is a significant minority of our hours.

A 34 question survey(1) (and a more recently modified 24 question version(2)) aimed at rating patient satisfaction has been validated and used in critical care units across Canada and the USA, and utilised widely with translations across Europe. It broadly examines two dimensions: “care” and “information and decision-making”. Relatives grade their experience and opinion on familiar 5-point Likert scales. In a Swiss published survey(3) of 996 family members, poor satisfaction was associated with high patient:nurse ratios and written admission / discharge criteria, whilst interestingly, high satisfaction was associated with more severely unwell patients.

A Canadian study(4) expanded this quantitative survey with free text summarised into themes. It highlights the variability between and within each ICU, and reports waiting rooms, patient rooms and communication with physicians as associated with negative comments. These themes have been echoed in a more recent German survey(5). This is perhaps in keeping with how resources (physician time and departmental finance) is directly at the patient, leaving the family and department aesthetics to suffer. The authors suggest low cost initiatives such as orientation brochures, tea / coffee facilities, availability of chairs for patient rooms, regular meetings with physicians and communication training.

A French team(6) compiled 2,135 questions asked by family members to physicians and nurses from various sources, and processed them down to 21 common and importantly rated questions. Although none are a great surprise, as by definition they were both common and important, it provides an evidence base upon which family information, department brochures and medical training can be based. Trials investigating specific interventions are hard to find. In a USA surgical ICU, an observational study(7) demonstrated improved satisfaction with implementation of a full-time family support coordinator, which is not hard to imagine. The study also tried to link this intervention to a reduced length-of-stay and financial cost, but failed to find any significant difference. Meanwhile, the Vanderbilt University group have shown little benefit from regular, organised communication clinics with families(8).

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References:

1 Heyland DK, and Tranmer JE. Measuring family satisfaction with care in the intensive care unit: The development of a questionnaire and preliminary results. Journal of Critical Care 2001; 16(4): 142-9.
2 Wall RJ, et al. Refinement, scoring, and validation of the Family Satisfaction in the Intensive Care Unit (FSICU) survey. Critical Care Medicine 2007; 35(1): 271-9.
3 Stricker KH, et al. Family satisfaction in the intensive care unit: what makes the difference? European Journal of Intensive Care Medicine 2009; 35(12): 2051-9.
4 Henrich NJ, et al. Qualitative analysis of an intensive care unit family satisfaction survey. Critical Care Medicine 2011; 39(5): 1000-5.
5 Schwarzkopf D et al. Family satisfaction in the intensive care unit: a quantitative and qualitative analysis. Intensive Care Medicine 2013; 39(6): 1071-9. doi:10.1007/s00134-013-2862-7
6 Peigne V, et al. Important questions asked by family members of intensive care unit patients. Critical Care Medicine 2011; 39(6): 1365-71. doi:10.1097/CCM.0b013e3182120b68.
7 Sheilton W et al. The effect of a family support intervention on family satisfaction, length-of-stay, and cost of care in the intnsive care unit. Critical Care Medicine. 2010; 38:1315-20.
8 Jacobowski NL, et al. Communication in Critical Care: Family Rounds in the Intensive