Rounding Summaries for Families of Critically Ill Patients

Rush University Medical Center252 enrolled

Overview

Many patients in intensive care units (ICUs) rely on family members or surrogates to make medical decisions on their behalf. One of the recommended ways to improve a surrogate's experience is to invite him or her to participate in daily, multidisciplinary ICU rounds. In practice, this is often a challenging way for clinicians to engage with the patient's surrogates. Surrogates of non-decisional ICU patients will be randomized to receive a written rounding summary every day or every other day that the patient is in the ICU. The summary will be organized as follows for each of the most important ICU problems: 1) Description of the problem, 2) Ways the ICU team is addressing the problem i.e. consultations, diagnostic tests, and treatments. 3) An assessment of whether the problem is improving or worsening. The investigators hypothesize that surrogates who receive written rounding summaries will be more satisfied with ICU care than surrogates who receive usual care. Satisfaction will be measured by the Critical Care Family Needs Inventory (CCFNI) questionnaire.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Enrollment

252

Conditions

Acute Respiratory Failure Intensive Care Unit Syndrome

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Patients in the adult Medical and Cardiac ICUs at Rush University Medical Center will be prospectively screened. Inclusion criteria (Patient characteristics required for surrogate inclusion) At least one of the following * The patient has required invasive or non-invasive mechanical ventilation for at least three consecutive days. * The patient has an expected in-hospital mortality rate of at least 25% according to the primary ICU physician. Exclusion criteria (Patient characteristics that will exclude surrogates from study enrollment): * The patient possesses decisional capacity at the time of enrollment. * The patient has required invasive or non-invasive mechanical ventilation for more than the previous 14 days * The patient is expected to die or transition to comfort care within the next 48 hours based on ICU physician estimate. * The patient is expected to be liberated from mechanical ventilation (if applicable) or discharged from the ICU within the next 24 hours. * There is no identifiable surrogate. * The patient is member of a vulnerable population i.e. pregnant, prisoner. * The ICU physician refuses permission to approach surrogates for consent The investigators will hand out fliers that describe the study to surrogates of patients who are expected to meet the above criteria. Surrogates can ask the nurse to contact the lead investigator if they are interested in learning more about the study. If no surrogate is present prior to the patient meeting the inclusion criteria, the investigators will attempt to contact the surrogate by phone to provide information on the study. One surrogate will be approached for informed consent and enrolled based on the following criteria. Inclusion criteria for surrogate decision maker: * Age ≥ 18 years old * Self-identified as participating directly in health care decision making for the incapable patient Exclusion criteria for surrogate decision makers: * The surrogate does not agree to participate in study procedures (surveys, interviews) * The surrogate needs translation assistance because of poor English fluency * The surrogate has history of a clinically important neurological disorder (e.g., dementia)

Outcomes

Primary Outcomes

Surrogate Satisfaction with Patient Care: Critical Care Family Needs Inventory (CCFNI) questionnaire

Score on the Critical Care Family Needs Inventory (CCFNI) questionnaire. 14 questions. Total score range 14-56 with lower scores indicating better satisfaction.

Time frame: Measured once 5-7 days after enrollment (or within 24 hours of ICU discharge if this occurs first). For patients who remain in the ICU an additional 5 days after first measurement, the outcome will be measured again.

Secondary Outcomes

Surrogate Anxiety and Depression

Score on Hospital Anxiety and Depression Scale (HADS). Total score 0-21 for anxiety (7 questions) and 0-21 for depression (7 questions). Higher scores indicate greater symptom burden.

Surrogate Symptoms of Post-Traumatic Stress Disorder (PTSD)

Score on Impact of Events Scale Revised (IES-R) questionnaire. 22 questions. Score 0-88 with higher scores indicating more stress.

Surrogate and physician agreement regarding the patient's condition

Surrogates and ICU physicians will be provided with a list of common medical ICU diagnoses. Respondents will be asked to indicate which of these diagnoses, if any, pertain to the patient. When the respondent picks a diagnosis, he or she will be prompted to indicate whether common treatments for that condition are being provided. Finally, for each checked diagnosis, the respondent will indicate whether he or she believes the problem is "getting better, getting worse, or staying the same." Members of the research team, blinded to the surrogates' treatment arm, will evaluate for inter-rater agreement between surrogates and ICU physician responses.

Change in Surrogate Satisfaction with Patient Care: Critical Care Family Needs Inventory (CCFNI) questionnaire

Change in Score on the Critical Care Family Needs Inventory (CCFNI) questionnaire. 14 questions. Total score range 14-56 with lower scores indicating better satisfaction.

Time frame: From enrollment to 5-7 days after enrollment (or within 24 hours of ICU discharge if this occurs first).

Change in Surrogate Anxiety and Depression

Change in Score on Hospital Anxiety and Depression Scale (HADS). Total score 0-21 for anxiety (7 questions) and 0-21 for depression (7 questions). Higher scores indicate greater symptom burden.

Time frame: From enrollment to 5-7 days after enrollment (or within 24 hours of ICU discharge if this occurs first).

Change in Surrogate Symptoms of Post-Traumatic Stress Disorder (PTSD)

Change in score on Impact of Events Scale Revised (IES-R) questionnaire. 22 questions. Score 0-88 with higher scores indicating more stress.

Time frame: From enrollment to 5-7 days after enrollment (or within 24 hours of ICU discharge if this occurs first).

Rounding Summaries for Families of Critically Ill Patients

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes