Date of Award

January 2018

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

David Y. Hwang

Abstract

DEDICATED AFTERNOON ROUNDS FOR ICU PATIENTS’ FAMILIES AND FAMILY SATISFACTION WITH CARE

Urs M.Weber1; Jennifer Johnson2; Nathanial Anderson3; Andrea K. Knies4; Belinda Nhundu1; Cynthia Bautista5; Kevin B. Huang6; Muhammad Hamza1; Jessica White2; Anna Coppola2; Kathleen M. Akgün7; David M. Greer2, 8, Evie G. Marcolini2, 8; Emily J. Gilmore2, 8; Nils H. Petersen2, 8; Nona Timario2; Kelly Poskus2; Kevin N. Sheth2, 8, David Y. Hwang2, 8

1Yale School of Medicine, New Haven, CT; 2Yale-New Haven Hospital, New Haven, CT; 3Hill Country Health and Wellness Center, Round Mountain, CA; 4Yale School of Nursing, New Haven, CT; 5Fairfield University School of Nursing, Fairfield, CT; 6Yale College, New Haven, CT; 7Department of Internal Medicine, Pulmonary, Critical Care and Sleep Medicine Section, VA Connecticut Healthcare System and Yale University School of Medicine, West Haven, CT; 8Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT

It was hypothesized that adding dedicated afternoon rounds for patients’ families to supplement standard family support would improve overall family satisfaction with care in a neuroscience intensive care unit (NICU).

Patients in the NICU admitted for longer than 72 hours or made comfort measures only at any point during NICU admission were eligible for participation. The on-service attending intensivist and a NICU nursing leader made bedside visits to families to address concerns during regularly scheduled, advertised times two afternoons each week.

One family member per patient during the pre-implementation (pre-I) and post-implementation (post-I) periods was recruited to complete the Family Satisfaction in the ICU 24 (FS-ICU 24) instrument. Post-I respondents indicated whether they had participated in the afternoon rounds. For primary outcome, the mean pre-I and post-I composite FS-ICU 24 scores (on a 100-point scale) were compared. A total of 146 pre-I (Mar 2013-Oct 2014; capture rate 51.6%) and 141 post-I surveys (Oct 2014-Dec 2015; 47.2%) were collected. There was no difference in mean FS-ICU score between groups (pre-I 89.2 ± 11.2, post-I 87.4 ± 14.2, p=0.6). In a secondary analysis, there was also no difference in mean FS-ICU score between the pre-I respondents and the 39.0% of post-I respondents who participated in family rounds. The mean FS-ICU score of the post-I respondents who reported no participation trended lower than the mean pre-I score, with fewer respondents in this group reporting complete satisfaction with emotional support (75% vs. 54%, p=0.002), coordination of care (82% vs. 68%, p=0.03), and frequency of communication by physicians (60% vs. 43%, p=0.03).

Dedicated afternoon rounds for families twice a week may not necessarily improve an ICU’s overall family satisfaction. Increased dissatisfaction among families who do not or cannot participate is possible.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/25/2100

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