Measuring the ability to meet family needs in an intensive care unit

Abstract

Objective: To measure the ability to meet family needs in an intensive care unit (ICU). Design: Descriptive survey. Setting: University hospital ICU. Subjects: Ninety-nine next of kin respondents and 16 secondary family respondents were recruited. Interventions: A modified Society of Critical Care Medicine Family Needs Assessment instrument was used. Measurements and Main Results: Demographic variables included patient age, gender, diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission, Therapeutic Intervention Scoring System (TISS) score on the date of interview, cumulative TISS of the ICU on the day of interview, number of patients in the ICU at time of interview, nurse/patient ratio for the patient, average nurse/patient ratio of the entire unit, day of the week of the interview, timing of the interview, number of ICU attending physicians who cared for this patient (scheduled for a period of seven consecutive days), number of nurses who cared for the patient, if a nurse was assigned the same patient on two consecutive days worked, length of stay in the ICU, and length of hospital stay. Demographic information concerning the family member included gender, age, commuting time to the hospital, visiting time in the hospital per day, number in family group, relationship to the patient, ethnic background, and education level. The additive score of all questions in the needs assessment instrument was calculated and used as the dependent variable. The independent variables were demographic information concerning patients, ICU, and respondents. The model coefficient of determination (R2adj) was 0.20 with a p = .0079. Greater family dissatisfaction (i.e., higher score) was present if there were more than two ICU attendings per patient (p = .048), or if the same nurse was not assigned on two consecutive days (p = .044). Family satisfaction increased if the respondent was female (p = .006), if the patient had a higher APACHE II score (p = .007), and if the patient's relationship with the most significant family member was brother/sister (p = .012). The family needs instrument was reliable and demonstrated a high degree of concordance with a second respondent in the same family surveyed. Conclusions: Communication by the same provider was important when measuring the ability of an ICU to meet family needs. Instrument scores and the ability to meet family needs differed depending on the gender and the relationship to the patient of the most significant family member. We speculate that this instrument may be a useful adjunct in assessing quality of critical care services provided. (Crit Care Med 1998; 26:266-271) In critical care, the quality of care provided has traditionally focused on the provider[1], the process of care [2], and biological outcomes [3]. Recent trends, however, have promoted consumer roles in judging providers [4-7] and making autonomous patient-centered decisions about medical care[8-10]. The focus on quality may be attributable to a variety of forces including: counter balance against the desire to minimize costs [11], external accreditation [12], consumer sovereignty [13], and importance of holistic care [14]. Providers may agree that consumer satisfaction is a valid assessment on “how well liked is the care provided” but providers may not agree that consumers can assess “technical quality of that care provided.” Studies [15,16] suggested that bias and personal characteristics regarding the technical quality of care are not the sole criteria in consumer's assessment of the technical aspects of medical care. Before agreement on who and how care can be assessed is possible, the needs of providers, patients, and families need to be explored. Preferences concerning the value of critical care differ widely among consumers and providers [17-19]. We argue that in general, patients’ judgment of care is both valuable and meaningful. Feedback to the provider of patients’ assessment of care can result in behavior modification [20]. Feedback allows the provider to appropriately tailor qualitative or quantitative aspects of care in order to meet desired outcomes [5]. The relevance of consumer satisfaction to critical care medicine is unknown. Relevance depends on values and philosophy of care as well as the impact of care on outcomes. Reports of consumer satisfaction using surveys based on hospital census are not specific for care provided in the intensive care unit (ICU) [16]. In critical care, the focus is often on family-provider interaction rather than the patient-provider interaction [17,18]. The needs of family members after admission of patients to critical care units have been previously assessed [21-29]. Collation of results from these surveys incorporating the needs of participants and the intensity of care provided has resulted in the creation of a family needs instrument [30]. In this study, we wished to evaluate one such instrument and relate the scores to the demographic, physiologic, and administrative variables found within an ICU.