A Multicenter Ethnographic Study of Family Participation in Intensive Care Unit Rounds
CCCF ePoster library. Au S. Nov 9, 2018; 233324
Dr. Selena Au
Dr. Selena Au
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Abstract
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Introduction: Guidelines recommend offering family members of critically ill patients the option to attend interdisciplinary team rounds as a way to improve communication and satisfaction. Uncertainty remains around the benefits and risks.

 

Objectives: We conducted a multicenter multi-city ethnographic observational study to describe family attendance during interdisciplinary rounds in adult ICUs, and determine whether family attendance is associated with changes in rounding processes, including duration, nature of communication, trainee teaching and quality. 



Methods:  302 individual rounds on 210 unique patients under the leadership of 33 attending physicians in 7 hospitals across 3 Canadian cities were observed. Quantitative and qualitative data were collected using standardized observational tools.  

 

Results: Among the 302 rounds observed, family attended in 68 (23%) rounds, were present in ICU but did not attend in 59 (20%) rounds, and were absent from the ICU in 175 (58%) rounds. The median duration of rounds respectively for these three groups of patients was 20 (IQR 14-26), 16 (IQR 13-22) and 16 (IQR 10-23) minutes (p=0.01). There were no significant differences in prognostic discussions (35% vs 36% vs 36%, p=0.99) or bedside teaching (35% vs 37% vs 34%, p=0.88). The quality of rounds was not significantly associated with family attendance in rounds or presence in the ICU (quality score [1 (low) to 10 (high)] median 8 [IQR 7-8] vs 7 [IQR 6-9] vs 7 [IQR 6-9], p=0.11). Qualitative analyses suggested that family attendance may influence relationship building, information gathering, patient and family education, team dynamics, future family meetings, workflow, and shared clinical decision making.

 

Conclusion: Our results suggest family attendance in ICU rounds is associated with a modest increase in duration of rounds, but not with changes to frequency of trainee teaching, discussions of prognosis or quality of rounds. Family attendance in rounds may enhance communication and complement traditional family conferences.    


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