A quality improvement project regarding family communication within critical care

ABSTRACT

Introduction: Communication is central to high quality critical care (CC)1 and caring for family members is integral to the care of critically ill patients. Communication within the CC frequently does not meet families' needs,2 impacts informed decisions making3 and can result in psychological morbidity for patients and their families.4 During the COVID-19 pandemic communication was challenging with restricted family visiting. As part of our recovery strategy we aim to ensure that frequent, high quality communication remains a key aspect of critical care. There is currently no guidance relating to the frequency of family communication within critical care. Objective(s) Our aim was to review the frequency of family communication during CC admissions admission and to develop our own internal standards. Method(s) A retrospective audit was conducted of 110 admissions to Guys and St Thomas' CC from November 2021 - February 202. We reviewed all routine family discussions documented in the medical notes. Data regarding the patient's length of stay, time to first communication from admission, frequency of communication throughout admission and grade of clinician leading the communication was collected. Family discussion regarding adverse incidents and admissions less than 24hrs were excluded. If multiple communications occurred on the same day, the most senior communication was included. To complement the audit a short survey of the consultants, regarding expectations and standards of practice of family communication was completed. Result(s) 99 patients were included within the audit and 13 responses to the survey (34% response). The mean length of stay for all patients was 14 days for survivors and 16.5 days for those who died. 32% of patients received a document family communication within 24hrs of admission, 34% did not have a documented communication within 72 hours of admission. 58.3% of consultants felt a family update should happen within 24hrs of admission and 84.7% of consultants reported that families should be updated once every 3 days. On average families received a documented family communication every 5.5 days of a CC admission. When focusing just on patients who died there was an increase in the frequency of communication to once every 3 days. 23% of all documented family discussions were consultant led with the number rising to 44% in non-survivors. The audit also showed that the longer a patient stayed within critical care the less frequently a family communication became. The survey indicated that the two biggest barriers to family communication is time pressures and appropriate space. Conclusion(s) We demonstrated that documented family communication was less frequent than expected. To ensure that family commination remains a key component of CC within our department we have adopted or own internal standard of providing families with an update once every 3 days. We are exploring the role of communication facilitators5 and seeking patient/family feedback also to improve family communication further.