Study examines perspectives linked to family-centered ICU rounds

Sep 1 2016

Families are increasingly welcome in intensive care units (ICUs), including as active participants in discussions with physicians and nurses during daily bedside rounds.

Given the choice, more than 85 percent of families prefer to be present during bedside rounds while a loved one is critically ill, but including them is more complex than it may seem.

A study in the September 2016 issue of the American Journal of Critical Care (AJCC) examines perspectives related to family-centered rounds in the ICUs, which involve planned, purposeful interactions between families and the ICU team at the patient's bedside.

The study, "Perceptions of Family Participation in Intensive Care Unit Rounds and Telemedicine: A Qualitative Assessment," identifies facilitating elements and potential barriers to involving families during bedside rounds in ICUs. It also explores the potential of telemedicine platforms to allow families to participate virtually in ICU rounds.

Co-author Daniel Holena, MD, MSCE, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania in Philadelphia, said, "Family participation in ICU rounds is an important tool to refocus delivery of care around the needs of patients, but there is little literature about it and the practice is often inconsistent." He added, "By identifying barriers and exploring solutions, we can encourage adoption of family-centered rounds in more ICUs."

For the study, led by Elisabeth A. Stelson, MSW, MPH, an interdisciplinary team conducted in-depth interviews with 20 family members of patients who had been admitted to the surgical ICU at a large, urban teaching hospital. They also interviewed 12 ICU providers, including staff nurses, advanced practice nurses, resident physicians and attending physicians.

The interviews revealed four elements that facilitated communication in rounds, including how a longer length of stay and familiarity with medical concepts and language increased family members' comfort in joining rounds. Other facilitators were a desire to understand the prognosis and trusting the ICU care team.

The researchers identified three primary barriers to family-provider communication during rounds, including family members being wary of interrupting the discussion among providers. Both family members and providers noted how medical language was a barrier to initiating communication with providers, while providers noted the challenges of sharing difficult information during rounds while families were experiencing heightened emotions.

The interviews showed that family members may not be able to attend rounds due to distance, work and family obligations, and the rounding schedule. The lack of a predetermined schedule for morning rounds presented additional challenges for families to be present at the bedside.

As part of the study, the researchers inquired about family and provider perceptions related to using telemedicine to communicate about patient care. They noted how telemedicine could make participation in ICU rounds more convenient by eliminating travel to the hospital and coordinating virtual participation with other family commitments.

"Virtual participation in ICU rounds would not replace a family member's presence at the bedside but could offer a supplemental way to improve communication between clinicians and families," Holena noted. "The future of using telemedicine for virtual family participation in rounds will depend on user-friendly and reliable platforms."

Source: American Association of Critical-Care Nurses (AACN)