Why involving family in ICU rounds may boost care quality

Hospitals that let families of patients in the intensive care unit attend physicians' rounds could improve care quality by improving satisfaction and communication, a study in Critical Care Medicine found.

"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," lead author Selena Au, MD, an assistant professor of critical care medicine at the University of Calgary in Canada, told Reuters. "When a patient is sedated or too ill, the family becomes that voice," Dr. Au said. "We're evolving past the times of separate formal family meetings."

To assess how family participation affects the rounding process, the researchers observed ICU rounds at seven hospitals in three cities in Alberta, Canada, during the spring and summer of 2016.

The medical teams usually consisted of a physician, charge nurse, bedside nurse, respiratory therapist and pharmacist. Medical trainees, dieticians and physical therapists were sometimes involved as well.

Out of 302 rounds that involved 210 patients, family attended roughly one-quarter of the sessions (68). In another 59 instances, patients' families were present in the ICU but did not attend the rounds. Family members were not present for the majority of the rounds.

The researchers found the rounds lasted about four minutes longer when family members were present. They did not find significant differences in the discussions physicians had about patient prognosis or in bedside teaching whether family members were attending or not.

The study authors argue family attendance could lead to improvements in information-gathering, team dynamics, physician-patient-family relationships, 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," Dr. Au told Reuters. "Although guidelines suggest having family at these meetings, we're still learning the specifics about how to do so."

Dr. Au said the next step is to find the best ways to reduce confusion for families and medical language they do not understand, as well as reduce nervousness of physicians who are concerned about how to phrase sensitive discussions with families.

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