Family Meetings in the Intensive Care Unit During the Coronavirus Disease 2019 Pandemic

Purpose: Visitor restrictions during the COVID-19 pandemic limit in-person family meetings for hospitalized patients. We aimed to evaluate the quantity of family meetings by telephone, video and in-person during the COVID-19 pandemic by manual chart review. Secondary outcomes included rate of change in patient goals of care between video and in-person meetings, the timing of family meetings, and variability in meetings by race and ethnicity. Methods: A retrospective cohort study evaluated patients admitted to the intensive care unit at an urban academic hospital between March and June 2020. Patients lacking decision-making capacity and receiving a referral for a video meeting were included in this study. Results: Most patients meeting inclusion criteria (N = 61/481, 13%) had COVID-19 pneumonia (n = 57/61, 93%). A total of 650 documented family meetings occurred. Few occurred in-person (n = 70/650, 11%) or discussed goals of care (n = 233/650, 36%). For meetings discussing goals of care, changes in patient goals of care occurred more often for in-person meetings rather than by video (36% vs. 11%, p = 0.0006). The average time to the first goals of care family meeting was 11.4 days from admission. More documented telephone meetings per admission were observed for White (10.5, SD 9.5) and Black/African-American (7.1, SD 6.6) patients compared to Hispanic or Latino patients (4.9, SD 4.9) (p = 0.02). Conclusions: During this period of strict visitor restrictions, few family meetings occurred in-person. Statistically significant fewer changes in patient goals of care occurred following video meetings compared to in-person meetings, providing support limiting in-person meetings may affect patient care.

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The Timing of Family Meetings in the Medical Intensive Care Unit

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119843133 ◽

2019 ◽

Vol 36 (12) ◽

pp. 1049-1056 ◽

Cited By ~ 1

Author(s):

Gina M. Piscitello ◽

William M. Parham ◽

Michael T. Huber ◽

Mark Siegler ◽

William F. Parker

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Life Support ◽

Medical Intensive Care Unit ◽

Medical Center ◽

Academic Medical Center ◽

Patient Death ◽

Family Meeting ◽

Family Meetings ◽

Medical Intensive Care

Purpose: Family meetings in the medical intensive care unit can improve outcomes. Little is known about when meetings occur in practice. We aimed to determine the time from admission to family meetings in the medical intensive care unit and assess the relationship of meetings with mortality. Methods: We performed a prospective cohort study of critically ill adult patients admitted to the medical intensive care unit at an urban academic medical center. Using manual chart review, the primary outcome was any attempt at holding a family meeting within 72 hours of admission. Competing risk models estimated the time from admission to family meeting and to patient death or discharge. Results: Of the 131 patients who met inclusion criteria in the 12-month study period, the median time from admission to family meeting was 4 days. Fewer than half of patients had a documented family meeting within 72 hours of admission (n = 60/131, 46%), with substantial interphysician variability in meeting rates ranging from 28% to 63%. Patients with family meetings within 72 hours were 30 times more likely to die within 72 hours (32% vs 1%, P < .001). Of the 55 patients who died in the intensive care unit, 27 (49%) had their first family meeting within 1 day of death. Conclusions: Family meetings occur considerably later than 72 hours and are often held in close proximity to a patient’s death. This suggests for some physicians, family meetings may primarily be used to negotiate withdrawal of life support rather than to support the patient and family.

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Clinician-to-Clinician Communication of Patient Goals of Care Within a Surgical Intensive Care Unit

Journal of Surgical Research ◽

10.1016/j.jss.2019.02.036 ◽

2019 ◽

Vol 240 ◽

pp. 80-88 ◽

Cited By ~ 5

Author(s):

Brooks V. Udelsman ◽

Katherine C. Lee ◽

Lara N. Traeger ◽

Keith D. Lillemoe ◽

David C. Chang ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Goals Of Care ◽

Patient Goals ◽

Clinician Communication

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Early detection of critical illness outside the intensive care unit: Clarifying treatment plans and honoring goals of care using a supportive care team

Journal of Hospital Medicine ◽

10.1002/jhm.2660 ◽

2016 ◽

Vol 11 ◽

pp. S40-S47 ◽

Cited By ~ 8

Author(s):

Russ Granich ◽

Zoe Sutton ◽

Yan S. Kim ◽

Megan Anderson ◽

Helen Wood ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critical Illness ◽

Early Detection ◽

Supportive Care ◽

Care Team ◽

Goals Of Care ◽

Treatment Plans

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Development and evaluation of the focused assessment of sonographic pathologies in the intensive care unit (FASP-ICU) protocol

Critical Care ◽

10.1186/s13054-021-03811-2 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Stefan Schmidt ◽

Jana-Katharina Dieks ◽

Michael Quintel ◽

Onnen Moerer

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Conclusive Evidence ◽

Rate Of Change ◽

University Hospital ◽

High Rate ◽

Whole Body ◽

Routine Surveillance ◽

Organ Systems ◽

Training Schemes

Abstract Background The use of ultrasonography in the intensive care unit (ICU) is steadily increasing but is usually restricted to examinations of single organs or organ systems. In this study, we combine the ultrasound approaches the most relevant to ICU to design a whole-body ultrasound (WBU) protocol. Recommendations and training schemes for WBU are sparse and lack conclusive evidence. Our aim was therefore to define the range and prevalence of abnormalities detectable by WBU to develop a simple and fast bedside examination protocol, and to evaluate the value of routine surveillance WBU in ICU patients. Methods A protocol for focused assessments of sonographic abnormalities of the ocular, vascular, pulmonary, cardiac and abdominal systems was developed to evaluate 99 predefined sonographic entities on the day of admission and on days 3, 6, 10 and 15 of the ICU admission. The study was a clinical prospective single-center trial in 111 consecutive patients admitted to the surgical ICUs of a tertiary university hospital. Results A total of 3003 abnormalities demonstrable by sonography were detected in 1275 individual scans of organ systems and 4395 individual single-organ examinations. The rate of previously undetected abnormalities ranged from 6.4 ± 4.2 on the day of admission to 2.9 ± 1.8 on day 15. Based on the sonographic findings, intensive care therapy was altered following 45.1% of examinations. Mean examination time was 18.7 ± 3.2 min, or 1.6 invested minutes per detected abnormality. Conclusions Performing the WBU protocol led to therapy changes in 45.1% of the time. Detected sonographic abnormalities showed a high rate of change in the course of the serial assessments, underlining the value of routine ultrasound examinations in the ICU. Trial registration The study was registered in the German Clinical Trials Register (DRKS, 7 April 2017; retrospectively registered) under the identifier DRKS00010428.

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Pediatric Chronic Critical Illness, Prolonged ICU Admissions, and Clinician Distress

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1724098 ◽

2021 ◽

Author(s):

Alison H. Miles ◽

Cynda H. Rushton ◽

Brian M. Wise ◽

Aka Moore ◽

Renee D. Boss

Keyword(s):

Intensive Care Unit ◽

Content Analysis ◽

Intensive Care ◽

Critical Illness ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Goals Of Care ◽

Chronic Critical Illness ◽

Conventional Content Analysis ◽

Clinical Interactions

AbstractTo gain an in-depth understanding of the experience of pediatric intensive care unit (PICU) clinicians caring for children with chronic critical illness (CCI), we conducted, audiotaped, and transcribed in-person interviews with PICU clinicians. We used purposive sampling to identify five PICU patients who died following long admissions, whose care generated substantial staff distress. We recruited four to six interdisciplinary clinicians per patient who had frequent clinical interactions with the patient/family for interviews. Conventional content analysis was applied to the transcripts resulting in the emergence of five themes: nonbeneficial treatment; who is driving care? Elusive goals of care, compromised personhood, and suffering. Interventions directed at increasing consensus, clarifying goals of care, developing systems allowing children with CCI to be cared for outside of the ICU, and improving communication may help to ameliorate this distress.

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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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Breaking Bad News and Discussing Goals of Care in the Intensive Care Unit

AACN Advanced Critical Care ◽

10.4037/nci.0000000000000082 ◽

2015 ◽

Vol 26 (2) ◽

pp. 131-141 ◽

Cited By ~ 1

Author(s):

Sheryl L. Hollyday ◽

Denise Buonocore

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Bad News ◽

High Stakes ◽

Goals Of Care ◽

Life And Death ◽

Breaking Bad ◽

Aggressive Care ◽

Delivering Bad News ◽

Practice Patient

The intensive care unit is a high-stakes environment in which nurses, including advanced practice registered nurses (APRNs), often assist patients and families to navigate life and death situations. These high-stakes situations often require discussions that include bad news and discussions about goals of care or limiting aggressive care, and APRNs must develop expertise and techniques to be skilled communicators for conducting these crucial conversations. This article explores the art of communication, the learned skill of delivering bad news in the health care setting, and the incorporation of this news into a discussion about goals of care for patients. As APRNs learn to incorporate effective communication skills into practice, patient care and communication will ultimately be enhanced.

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