Communication in Intensive Care

Group “Communication”D Biarent, L Huygens, L Bossaert, De Jongh,

Y Somers, M Laurent, M Slingemeyer

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;13:2-3Jacob 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

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

Query

Evaluation of modalities of reception of a patient and his family in ICUArchitecture for reception/admissionSchedules and organisation for visiting

ICU patientPremises

Communication (indirect evaluation)Identification of HCPModalities of information of relativesDelivery of bad news/prognosisModalities of information of GP

TeamPsychological supportEducationTransmission of informationFilesDNR order

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

Interviews with family are frequent but not structured

Possibility for family to stay during night are scarce

Bad news delivery

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

Structured interview with relatives: teaching & discussion

Discussion/communication after bad news deliveryUnformal: 63%Organised during staff meeting: 66%Psychiatrist liaison meeting: 8%Written report: 55%

Team psychologic help / support

Individual systematic: 5%Individual on request: 29%Group systematic: 11%Group on request: 24%

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%

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%

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