Communication in intensive care

Communication in Intensive Care

Group “Communication”

D Biarent, L Huygens, L Bossaert, De Jongh, Y Somers, M Laurent, M Slingemeyer

Goals of communication

 Quality of communication between HCP and family could play a role on recovery of patients Tilly, AJM 2000

 Family want to be informed and to participate to medical decision

Molter DCCN, 1994;13:2-3

Jacob Am J Crit Care, 1998;7:30-36

 Family are waiting honest information Harvey Crit Care Med, 1993;4:484-549

 No rational behind exclusion of the family during care of the patient

Robinson Lancet, 1998;352:614-17

Query

Ideally : query directed to patient and/or family

Questionnaire directed to ICU directors

 Only on voluntary basis

 Profile of all Belgian units

 Indirect tools to measure level of information

and communication

Query

 Evaluation of modalities of reception of

a patient and his family in ICU

Architecture for reception/admission

Schedules and organisation for visiting ICU patient

 Communication (indirect evaluation)

Modalities of information of relatives Delivery of bad news/prognosis

Modalities of information of GP

 Team

Results

 Number of ICU 39 / 134 (28.3 %)  Number of beds 637

 Visits limited to less than 2 h/day  Children admitted from 10 y of age

 Family is accompanied by HCP during admission/resuscitation

 Relative not allowed to witness resuscitation / procedure

 Interviews with family are frequent but not structured

 Possibility for family to stay during night are scarce

Structured interview with

relatives: who speaks

Intensivists 82% Dr in charge 63% Specialists 50% Psychologist 13% Resident 39% Nurse 63% Cultural repres 26% GP 26% Also present

Structured interview with

relatives: teaching & discussion

Discussion/communication after bad news delivery

Unformal: 63%

Organised during staff meeting: 66% Psychiatrist liaison meeting: 8%

Team psychologic help / support

Individual systematic: 5% Individual on request: 29% Group systematic: 11%

Patient’s files

 Fully computerised files : 30%  Partially computerised : 41%

 Limited access for some HCP categories : 91%  Nursing file access for relatives : 54%

Death of patients

 Family members are informed that death of their relative is near in 98%

 Relatives are present during the death event in 84%

 Relatives may stay longer in privacy with the deceased in 24%

Conclusion

 Obvious concern from majority of ICU to

communicate with relatives (dedicated HCP, frequent information during resuscitation, HCP identification, oldest children accepted)

 Presence during procedure and resuscitation, length of visit, possibility to stay with the patient, visit of

youngest children, bad news delivery modalities and teaching are subject to possible improvement

 Architectural limitation impairs confidentiality  Lack of psychological support