1239: IMPROVING INTERDISCIPLINARY CARE TEAM COMMUNICATION IN THE INTENSIVE CARE UNIT

Objectives: We conducted a pilot quality improvement (QI) project with the aim of improving accessibility of palliative care to critically ill neurosurgical patients. Methods: The QI project was conducted in the neurosurgical intensive care unit (NS-ICU). Prior to the QI project, referral rates to palliative care were low. The ICU-Palliative Care collaborative comprising of the palliative and intensive care team led the QI project from 2013 to 2015. The interventions included engaging key stake-holders, establishing formal screening and referral criteria, standardizing workflows and having combined meetings with interdisciplinary teams in ICU to discuss patients’ care plans. The Palliative care team would review patients for symptom optimization, attend joint family conferences with the ICU team and support patients and families post-ICU care. We also collected data in the post-QI period from 2016 to 2018 to review the sustainability of the interventions. Results: Interventions from our QI project and the ICU-Palliative Care collaborative resulted in a significant increase in the number of referrals from 9 in 2012 to 44 in 2014 and 47 the year later. The collaboration was beneficial in facilitating transfers out of ICU with more deaths outside ICU on comfort-directed care (96%) than patients not referred (75.7%, p < 0.05). Significantly more patients had a Do-Not-Resuscitation (DNR) order upon transfer out of ICU (89.7%) compared to patients not referred (74.2.%, p < 0.001), and had fewer investigations in the last 48 hours of life (p < 0.001). Per-day ICU cost was decreased for referred patients (p < 0.05). Conclusions: Multi-faceted QI interventions increased referral rates to palliative care. Referred patients had fewer investigations at the end-of-life and per-day ICU costs.

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The Impact of Implementing Critical Care Team on Open General Intensive Care Unit

Tuberculosis and Respiratory Diseases ◽

10.4046/trd.2012.73.2.100 ◽

2012 ◽

Vol 73 (2) ◽

pp. 100 ◽

Cited By ~ 1

Author(s):

Ick Hee Kim ◽

Seung Bae Park ◽

Seonguk Kim ◽

Sang-Don Han ◽

Seung Seok Ki ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Care Team ◽

General Intensive Care Unit ◽

The Impact ◽

Critical Care Team

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Electronic Health Record Tool to Promote Team Communication and Early Patient Mobility in the Intensive Care Unit

Critical Care Nurse ◽

10.4037/ccn2018813 ◽

2018 ◽

Vol 38 (6) ◽

pp. 23-34 ◽

Cited By ~ 4

Author(s):

Robert J. Anderson ◽

Kathleen Sparbel ◽

Rhonda N. Barr ◽

Kevin Doerschug ◽

Susan Corbridge

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Electronic Health Record ◽

Health Record ◽

Team Communication ◽

Patient Mobility ◽

Electronic Health

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Interdisciplinary Care and Communication in the Intensive Care Unit

Evidence-Based Critical Care ◽

10.1007/978-3-030-26710-0_105 ◽

2020 ◽

pp. 785-792

Author(s):

Jonathan Ludmir ◽

Judy Davidson ◽

Giora Netzer

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Interdisciplinary Care

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Navigator-Based Intervention to Support Communication in the Pediatric Intensive Care Unit: A Pilot Study

American Journal of Critical Care ◽

10.4037/ajcc2020478 ◽

2020 ◽

Vol 29 (4) ◽

pp. 271-282

Author(s):

Kelly N. Michelson ◽

Elizabeth Charleston ◽

Danica Y. Aniciete ◽

Lauren R. Sorce ◽

Patricia Fragen ◽

...

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Health Care Team ◽

Care Team ◽

Care Needs ◽

Family Meetings ◽

Family Perceptions

Background Communication in the pediatric intensive care unit (PICU) between families and the health care team affects the family experience, caregiver psychological morbidity, and patient outcomes. Objective To test the feasibility of studying and implementing a PICU communication intervention called PICU Supports, and to assess families’ and health care teams’ perceptions of the intervention. Methods This study involved patients requiring more than 24 hours of PICU care. An interventionist trained in PICU-focused health care navigation, a “navigator,” met with parents and the health care team to discuss communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and checked in with parents after PICU discharge. The feasibility of implementing the intervention was assessed by tracking navigator activities. Health care team and family perceptions were assessed using surveys, interviews, and focus groups. Results Of 53 families approached about the study, 35 (66%) agreed to participate. The navigator met with parents on 71% and the health care team on 85% of possible weekdays, and completed 86% of the postdischarge check-ins. Family meetings were offered to 95% of eligible patients. The intervention was rated as helpful by 97% of parents, and comments during interviews were positive. Conclusions The PICU Supports intervention is feasible to implement and study and is viewed favorably by parents.

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Use of telecritical care for family visitation to ICU during the COVID-19 pandemic: an interview study and sentiment analysis

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-011604 ◽

2020 ◽

pp. bmjqs-2020-011604

Author(s):

Farzan Sasangohar ◽

Atiya Dhala ◽

Feibi Zheng ◽

Nima Ahmadi ◽

Bita Kash ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Sentiment Analysis ◽

Family Members ◽

Automated Analysis ◽

Tertiary Hospital ◽

Care Team ◽

Patient Status ◽

Physical Presence ◽

Inductive Thematic Analysis

BackgroundWhen the COVID-19 pandemic restricted visitation between intensive care unit patients and their families, the virtual intensive care unit (vICU) in our large tertiary hospital was adapted to facilitate virtual family visitation. The objective of this paper is to document findings from interviews conducted with family members on three categories: (1) feelings experienced during the visit, (2) barriers, challenges or concerns faced using this service, and (3) opportunities for improvements.MethodsFamily members were interviewed postvisit via phone. For category 1 (feelings), automated analysis in Python using the Valence Aware Dictionary for sentiment Reasoner package produced weighted valence (extent of positive, negative or neutral emotive connotations) of the interviewees’ word choices. Outputs were compared with a manual coder’s valence ratings to assess reliability. Two raters conducted inductive thematic analysis on the notes from these interviews to analyse categories 2 (barriers) and 3 (opportunities).ResultsValence-based and manual sentiment analysis of 230 comments received on feelings showed over 86% positive sentiments (88.2% and 86.8%, respectively) with some neutral (7.3% and 6.8%) and negative (4.5% and 6.4%) sentiments. The qualitative analysis of data from 57 participants who commented on barriers showed four primary concerns: inability to communicate due to patient status (44% of respondents); technical difficulties (35%); lack of touch and physical presence (11%); and frequency and clarity of communications with the care team (11%). Suggested improvements from 59 participants included: on demand access (51%); improved communication with the care team (17%); improved scheduling processes (10%); and improved system feedback and technical capabilities (17%).ConclusionsUse of vICU for remote family visitations evoked happiness, joy, gratitude and relief and a sense of closure for those who lost loved ones. Identified areas for concern and improvement should be addressed in future implementations of telecritical care for this purpose.

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Impact of Built Design on Nighttime Family Presence in the Intensive Care Unit

HERD Health Environments Research & Design Journal ◽

10.1177/1937586719836287 ◽

2019 ◽

Vol 13 (1) ◽

pp. 106-113 ◽

Cited By ~ 1

Author(s):

Truong-Giang Huynh ◽

Robert L. Owens ◽

Judy E. Davidson

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Intensive Care ◽

Sleep Deprivation ◽

Care Team ◽

Night Sleep ◽

Family Presence ◽

Design Changes ◽

Before And After

Objective: Determine whether dedicated family space changes family presence at night in the intensive care unit (ICU). Purpose: To measure family presence at night before and after moving to an ICU with in-room family space. Background: The safeguarding phenomenon families experience may lead to the desire to sit vigil at the bedside. Lack of dedicated family sleep space may exacerbate sleep deprivation for those who wish to be present at night. Sleep deprivation decreases cognition and capacity for decision-making. Traditionally, ICU rooms have not included dedicated family areas or sleep surfaces. National recommendations include designing new hospital ICU rooms with dedicated family space. It is not known if the built design changes family presence at night. Method: Family presence was measured for 30 nights pre- and postmove to a newly built ICU with dedicated family space. The policy for open flexible family presence remained the same before and after the move. Results: There was a statistically significant increase in proportion of occupied patient rooms with visitors following the move to the new ICU designed with family space (31% difference, x2= 5.675, 95% CI [5.74, 51.29], p = .0172). Conclusions: Families utilize the space when available. Further research is needed to quantify quality and quantity of family sleep and impact on decision-making and interactions with the care team. Sleep deprivation may decrease for families who would have remained in the unit without available family space and sleep surface.

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