Thursday Jun 07, 2018
Hospitals that allow family members of critically ill patients to attend doctors’ rounds in the intensive care unit (ICU) may improve healthcare quality by enhancing communication and satisfaction, a Canadian study suggests.
Although family attendance could increase the time spent on rounds, it doesn’t affect the quality of rounds for doctors, nurses and trainees, nor the candor of discussions they have, the study authors report in Critical Care Medicine.
“In order to have patient-centered care, we need to have the patient’s voice be respected and heard, and in the ICU, that’s not always possible,” said lead author Dr. Selena Au, an assistant professor of critical care medicine at the University of Calgary.
“When a patient is sedated or too ill, the family becomes that voice,” Au said in a telephone interview. “We’re evolving past the times of separate formal family meetings.”
In the spring and summer of 2016, the researchers observed ICU rounds at seven hospitals in three cities in the province of Alberta to assess how family participation affects the rounding process. The medical teams typically included a doctor, charge nurse, bedside nurse, respiratory therapist and pharmacist. Sometimes medical trainees, dieticians and physical therapists were present as well.
Of the 302 rounds involving 210 patients, family attended 68, or about a quarter of the sessions. In another 59 instances, family were present in the ICU but didn’t attend the rounds. For the majority of the rounds, family were not present.
When family were present, rounds lasted about four minutes longer, the researchers found. However, there were no significant differences in the discussions doctors had about patient prognosis or in bedside teaching with or without family members attending.
In fact, the study authors write, family attendance might improve information gathering, team dynamics, doctor-patient-family relationship building, workflow and shared clinical decision-making.
“If we want to share decision-making with patients, then the family should be where the decisions are happening,” Au said. “Although guidelines suggest having family at these meetings, we’re still learning the specifics about how to do so.”
The next step is to find the best ways to reduce medical jargon and confusion for families, as well as nervousness for doctors who may be worried about how to phrase sensitive discussions around families, she said.
“We found that those little remarks about resident performance or another team’s care tend to be toned down, so we hear less sarcastic and judgmental language,” Au added. “Having family around may make rounds more crisp.”
Researchers also want to know why some families were present in the ICU but didn’t attend rounds.
If families didn’t know about the opportunity, hospitals should increase awareness, but if the families chose not to attend, doctors may want to understand why, said Dr. David Hwang of the Yale School of Medicine in New Haven, Connecticut, who wasn’t involved in the study.
“There’s a movement toward using technology to get families who couldn’t attend to be there through telemedicine, FaceTime or Skype. There may be ways to use technology in an organic way that isn’t obstructive to the team,” Hwang said in a telephone interview.
“Many families don’t realize they have the option of attending, and they need to feel free to join,” he added. “In an era of transparency and openness in critical care, we want families to be as involved as possible in medical decisions.”
A limitation of the study is that it was unable to measure the impact on patient outcomes. Future studies should look at whether this shared decision-making leads to better quality of care and fewer medical errors, said Dr. Paul Aronson of the Yale School of Medicine, who wasn’t involved in the research.
“My suspicion is that it doesn’t make a difference, but families do feel better, and that’s important,” Aronson said in a telephone interview, noting that sometimes families are able to give information that otherwise would have been missed.
“Family involvement in ICU rounds - anywhere in the hospital, really - should be an expectation,” he said. “Different families have different preferences, but it should be a standard of care now.”