Communication with the relatives of critically ill patients: an Audit and Discussion
Humble SR, Cole SJ, Antoniewicz P, Colvin JR
Dept of Intensive Care, Ninewells Hospital, Dundee, Scotland
Introduction Good communication is an essential part of medical and nursing care. It facilitates the diagnostic process and minimises the emotional distress experienced by patients and their relatives. Indeed, visiting a close relative in ICU can be associated with symptoms related to post-traumatic stress disorder.1,2This study evaluated the effectiveness of communication from two perspectives. The results were compared against a national framework of recommended standards.3
Methods We prospectively audited the frequency and location of interviews that occurred between ICU staff and patient’s relatives from Feb to Jun 2006. After discharge from ICU, the relatives were asked to complete a retrospective anonymous questionnaire regarding their experience.
ResultsOf the 106 admissions to ICU within the time period we studied data from 80 patients. The remainder met the exclusion criteria. 30% of relatives were interviewed within 15 minutes of arrival by nursing staff, while 28% were interviewed by medical staff within 60 minutes. Nursing staff spoke to the relatives on 74% of days and medical staff spoke on 57% of days. 21% of patients received no visitors. 41 of the patient’s relatives were given questionnaires to complete, the results from these were very positive.
Discussion The targets proposed by the RCoA Audit Compendium3were not met during the study period but there were high levels of satisfaction. The needs of relatives include the opportunity to effectively appraise a situation that is perceived as harmful, to assimilate the information and to formulate a coping strategy.4,5The overall impression a visitor forms of ICU is heavily influenced by the communication skills of the staff and effective communicators are also less likely to receive complaints.6The subjective nature of communication makes it difficult to quantify and difficult to measure definitively. As a surrogate marker of quality, we assessed the quantity and frequency of discussions. Arbitrary end points are unable to measure crucial elements of the interaction process or patient perspectives. Communication is a dynamic process rather than a fixed sequence of events. It has been suggested that an assessment of Doctor and Patient perceptions should be used, based on the premise that subjective measurements may be more useful than objective ones in this context.7However, these are highly complex to measure; ipso facto very few studies have been completed in this area to support this assertion.
Conclusion High quality communication is something to which we should all aspire. The strict use of inflexible targets is not necessary to promote good communication, but serves as a benchmark to raise the profile of this issue. Emphasis should be placed on integrating a routine interview process into clinical care.
- Azoulay E, Pochard F, Kentish-Barnes N et al.Risk of post-traumatic stress symptoms in family members of intensive care patients. Am J Respir Crit Care2005 171: 987-994
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- Jayaprakash V, Smith GB. Communication with relatives or visitors of ICU patients. RCoA. A compendium of audit recipes.Critical care services 10.9
- McGaughey J, Harrisson S. Understanding the pre-operative information needs of patients and their relatives in intensive care units. Int Crit Care Nurs1994; 10: 186-194
- Lazarus RS, Folkman S. Stress, Appraisal and Coping. Springer Publishing Company. New York. 1984
- Levinson et al. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA. 1997; 277(7): 533-599
- Hagihara A, Tarumi K. Doctor and patient perceptions of the level of doctor explanation and quality of patient-doctor communication. Scand J Caring Sci2006; 20: 143-150
- Travaline JM, Ruchinskas R, D’Alonzo GE. Patient-physician communication: why and how? Journal of the American Osteopathic Association2005; 105: 13-18