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• W2535273330 abstract "SESSION TITLE: Education, Research, and Quality Improvement II SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Critical illness, sedation and co-morbidities may incapacitate a patient, such that ICU provider communication may be only via surrogate decision makers, often families. Family satisfaction is considered a marker for quality ICU care. Our objective of this study is to: 1) Systematically measure family satisfaction for patients of the ICU. 2) Identify factors for family dissatisfaction or breaks in the system for quality healthcare delivery. 3) Use the survey results to design quality improvement (QI) projects and monitor its impact. METHODS: This is a prospective observational cohort of measuring the satisfaction of families of patients consecutively admitted to a mixed medical-surgical ICU who meet the inclusion criteria during the study period: family members aged 18 yrs or older, English speaking, and patients hospitalized in the ICU for 3 days or longer. Exclusion criteria include pregnant women, comfort care or expected mortality <24 hours from admission to the ICU, and lack of research authorization. The FS-ICU 24 has twenty-four items that ask respondents to rate their satisfaction with specific aspects of the ICU experience on a 5-point Likert-type response scale. This is modeled after the CMS public reporting of patient satisfaction. The Bereaved Family Survey Performance Measure (BFS-PM), an inpatient family satisfaction tool implemented nationally in the VA healthcare system, was used as a baseline for some of the key elements. After a root-cause analysis (RCA) for poor satisfaction of pain control, nursing education for assessment of non-verbal patients was provided. Families were educated on how nursing assess for pain. Also, we designed a nursing/provider communication checklist that included optimum pain management and adherence to bundles as the intervention. RESULTS: There were 21 family members who consented to the survey who met inclusion criteria. Of these only 10 completed surveys for the first PDSA cycle. The majority (70%) of families said they had less than 2 formal family meetings with the ICU team. The palliative care team was consulted for 60% of the family members, but 83% of the remaining families later requested information about palliative care. Areas for improvement include courtesy by ICU staff, atmosphere of ICU and its waiting room, ease of getting information and understanding it, feeling included and supported. There was an improvement in optimum pain management from 15% to 70%. The overall family satisfaction improved from 28% to 60%. CONCLUSIONS: In comparison to the baseline, there is an improvement in family satisfaction. This is attributed to improvement in pain control with several interventions including nursing/provider communication checklist, nursing education on a pain scale for non-verbal patients (Critical Care Pain Observation Tool), and family education on nursing pain assessments. The next phase will include QI projects to increase the number and focus for “VALUE” based family discussions and increasing palliative care consults. CLINICAL IMPLICATIONS: Optimum pain management for patients in ICU has shown to effectively improve family satisfaction. RCA done on other family grievances shows that VALUE based family meetings and palliative care consults could improve family satisfaction further. DISCLOSURE: The following authors have nothing to disclose: Chaitanya Mandapakala, Amaraja Kanitkar, Ravinder Bhanot, Sarah Lee No Product/Research Disclosure Information" @default.
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• W2535273330 date "2016-10-01" @default.
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• W2535273330 title "Improving Shared Medical Decision-Making Through Enhancing Family-Centered Healthcare Delivery in the ICU" @default.
• W2535273330 doi "https://doi.org/10.1016/j.chest.2016.08.715" @default.
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