Most patient family members hesitant to express safety concerns, study finds

The majority — 50 percent to 70 percent — of family members with a loved one in an intensive care unit said they were hesitant to voice their concerns about common care situations with safety implications, a study published in BMJ Quality and Safety found.

Six things to know:

1. Clinician-researchers at Beth Israel Deaconess Medical Center in Boston surveyed family members and patients with recent ICU experiences about how willing they felt to discuss care concerns with medical providers. 

"Speaking up is a key component of safety culture, yet our study — the first to our knowledge to address this issue — revealed substantial challenges for patients and families speaking up during an ICU stay," said co-lead author Sigall Bell, MD. "In the ICU setting in particular, families — who are also among the most vigilant stakeholders — may hold key information clinicians may have overlooked, and may be the first to detect a change in clinical status."

2. Using a questionnaire developed by a multidisciplinary group of experts in patient advisory and care quality, the researchers surveyed 105 families of patients admitted to an urban academic hospital's ICU from July 2014 to February 2015. They also surveyed a panel of 1,050 participants with recent ICU experience via the internet.

3. Although nearly two-thirds of ICU patients and families reported feeling very comfortable discussing medications, only about one-third of respondents said they felt very comfortable discussing hand hygiene or disagreements about aggressiveness of care desired by patients/families versus care clinicians proposed.

4. Only half of survey respondents felt very comfortable asking clinicians to clarify confusing or conflicting information or raising concerns about a possible error.

5. The most frequently cited reasons for that hesitancy included fear of being labeled a "troublemaker," not knowing whom to talk to, and knowing the medical team was busy.

6. "We were surprised not knowing who to talk to about concerns — a readily actionable issue — was among the most highly cited barriers," Dr. Bell said. "Our results highlight the need to explicitly support patients and families to speak up in real time about perceived errors. Hesitancy to do so represents a real safety gap."

The findings point to low-cost opportunities to improve patient and family outcomes. As a first step to improving outcomes, hospital leaders can implement systematic instructions about whom to contact with concerns, culturally reframe speaking up in a more positive way and ensure clinicians listen to patients and families when they do speak up, the researchers suggest.

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