Communication in Intensive Care

(1)

Communication in Intensive Care

Group “Communication”

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

(2)

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

(3)

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

 Sensitisation

(4)

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

Premises

(5)

 Communication (indirect evaluation)

Identification of HCP

Modalities of information of relatives

Delivery of bad news/prognosis

Modalities of information of GP

 Team

Psychological support

Education

Transmission of information

Files

DNR order

(6)

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

(7)

 Interviews with family are frequent but not structured

 Possibility for family to stay during night are scarce

 Bad news delivery

(8)

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

(9)

Structured interview with

relatives: teaching & discussion

Discussion/communication after bad news delivery

Unformal: 63%

Organised during staff meeting: 66%

Psychiatrist liaison meeting: 8%

Written report: 55%

(10)

Team psychologic help / support

Individual systematic: 5%

Individual on request: 29%

Group systematic: 11%

Group on request: 24%

(11)

Patient’s files

 Fully computerised files : 30%

 Partially computerised : 41%

 Limited access for some HCP categories : 91%

 Nursing file access for relatives : 54%

 Patient file access for relatives : 59%

(12)

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%

(13)

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