Presentation is loading. Please wait.

Presentation is loading. Please wait.

Using the FS-ICU Instrument: Understanding and Improving Family Satisfaction in a Neuro ICU David Y. Hwang, MD Assistant Professor of Neurology Division.

Similar presentations


Presentation on theme: "Using the FS-ICU Instrument: Understanding and Improving Family Satisfaction in a Neuro ICU David Y. Hwang, MD Assistant Professor of Neurology Division."— Presentation transcript:

1 Using the FS-ICU Instrument: Understanding and Improving Family Satisfaction in a Neuro ICU David Y. Hwang, MD Assistant Professor of Neurology Division of Neurocritical Care and Emergency Neurology Yale School of Medicine Jennifer Robinson, APRN Yale-New Haven Hospital

2 Open your control panel Join audio: Choose “Mic & Speakers” to use computer VoIP Choose “Telephone” and dial using the information provided Submit questions and comments via the Questions panel Note: Today’s presentation is being recorded and will be provided within 45 days. Your Participation Audience Participation

3 Please continue to submit your text questions and comments using the Questions Panel or Click Raise Hand button to be unmuted for verbal questions. Your Participation Audience Participation

4 Lori Harmon, RRT, MBA Director, Program Development Society of Critical Care Medicine Mount Prospect, IL Today’s webcast is supported by grant number R18HS021940 from the Agency for Healthcare Research and Quality. The content is solely The responsibility of the presenters and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

5 David Hwang, MD Assistant Professor of Neurology Division of Neurocritical Care and Emergency Neurology Yale School of Medicine

6 Jennifer Robinson, APRN Neuroscience ICU Yale-New Haven Hospital Adjunct Faculty Yale University

7 S L I D E 6 Using the FS-ICU instrument: Understanding and improving family satisfaction in a Neuro ICU SCCM Project Dispatch Webcast 02/05/2014 David Y. Hwang, MD Assistant Professor of Neurology Yale Division of Neurocritical Care and Emergency Neurology Jennifer Robinson, APRN Yale Neuroscience

8 S L I D E 7 Disclosures David Y. Hwang, MD –American Brain Foundation Practice Research Training Fellowship –Remedy Pharmaceuticals, Inc. (GAMES-RP clinical trial site PI) –Bayer HealthCare (legal consulting) –Oxford University Press (book) Jennifer Robinson, APRN –None

9 S L I D E 8 ngm.nationalgeographic.com

10 S L I D E 9 www.grassrootsmusic.org

11 S L I D E 10 Outline Importance of research on ICU family experiences Available survey tools for assessing family satisfaction –Focus on FS-ICU Multidisciplinary team approach at Yale for collecting survey data Details of data collection setup, including troubleshooting problems Recent survey results from Yale-New Haven Hospital Neuro ICU Possible future directions

12 S L I D E 11 Importance of research on ICU family experiences Institute of Medicine 2001 report –Recommendation for healthcare delivery to be “patient-centered” –Shared decision making –Coordinated care –Physical/emotional support –Culturally competent IOM. National Academies Press 2001

13 S L I D E 12 Importance of research on ICU family experiences Crit Care Med 2007;35:605

14 S L I D E 13 Importance of research on ICU family experiences As of October 2012, the Affordable Care Act ties consumer satisfaction to hospital reimbursement Medicare withholds 1% of normal reimbursement for a “bonus fund” Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey –Assesses patients’ perception of care –Scores factored into bonuses www.washingtonpost.com/blogs/wonkblog

15 S L I D E 14 Importance of research on ICU family experiences Does family satisfaction with ICU care correlate with long-term family outcomes? –Caregiver burden for survivors –Grief and bereavement for nonsurvivors –Postintensive care syndrome (PICS-F) Anxiety Depression PTSD Acute Stress Disorder Rothen et al. Curr Opin Crit Care 2010;16:623 Davidson et al. Crit Care Med 2012;40(2):618

16 S L I D E 15 Importance of research on ICU family experiences Despite existing controversies and uncertain influence of family satisfaction on long-term patient and family outcomes: –Satisfaction with medical care has become an important quality metric; –Surveys such as HCAHPS typically capture satisfaction data from patients themselves over the course of an entire hospital stay; –Quality improvement in ICUs should ideally be guided by ICU-specific information; –ICU family satisfaction research has thus received increasing attention over the past decade.

17 S L I D E 16 Rothen et al. Curr Opin Crit Care 2010;16:623

18 S L I D E 17 Available survey tools for assessing family satisfaction Critical Care Family Needs Inventory (CCFNI) Critical Care Family Satisfaction Survey (CCFSS) Family Satisfaction in the ICU (FS-ICU) –FS-ICU 34 –FS-ICU 24 Kentish-Barnes et al. Crit Care Med 2009;37(10):S448

19 S L I D E 18 Johnson et al. Crit Care Med 1998;26:266

20 S L I D E 19 Wasser et al. Crit Care Med 2001;29:192

21 S L I D E 20 FS-ICU Initially designed as a 34-item survey Half of items address satisfaction with overall care Half of items address satisfaction with the shared decision making process Survey refined and revalidated in 2007 as a 24-item version Heyland et al. J Crit Care 2001;16(4):142 Heyland et al. Crit Care Med 2002;30:1413 Wall et al. Crit Care Med 2007;35:271 www.thecarenet.ca

22 S L I D E 21 FS-ICU Available for free on the Internet Items are mostly scored on a 5-point Likert scale Each item can be scored out of 100 points Some overlap with patient HCAHPS questions Wide use in the literature –Multiple large observational cohorts –Used as outcome instrument for intervention studies Heyland et al. J Crit Care 2001;16(4):142 Heyland et al. Crit Care Med 2002;30:1413 Wall et al. Crit Care Med 2007;35:271 www.thecarenet.ca

23 S L I D E 22 FS-ICU

24 S L I D E 23 FS-ICU 3 items for family members whose relatives died during ICU stay: Length of unnecessary prolongation of life Comfort Support by care team during family member’s death

25 S L I D E 24 FS-ICU Recent ICU interventional trial using the FS-ICU as outcome instrument Qualitative analysis of write-in comments performed Recurring topics –Timeliness of information received –Appropriateness of communication in the patient care area –Comportment (professional vs. rude communication) Shaw, Davidson et al. Crit Care Med 2014;42(2):265

26 S L I D E 25 Yale multidisciplinary team Approval by local IRB Multidisciplinary approach vital to success –Recruitment of diverse group –Low turnover of team –Core group of 5 members recruiting families –Led by physician and NP –Nursing leadership CNS ICU nurse manager –Physician assistant –Staff RNs –PA student –Unit business associate / secretary

27 S L I D E 26 Nuts & bolts of data collection Monthly reminders to group to sign up for “call schedule” (M-F) Recorded in group Google calendar account “On-call” responsibilities: –Patient selection –Enrollment –Data collection Timeline –Window for recruitment 24 hours prior and 8 hours after discharge from ICU Family member selection Exclusion Criteria –Admission <72 hours, unless made comfort measures –Non English speaking

28 S L I D E 27 Nuts & bolts of data collection Survey converted from paper to Google survey Only de-identified information online Family and patient demographics stored separately Automatically inputs results into Excel spreadsheet Expired patients collected separately –Mailed letter detailing research study and paper version of survey –~1 month passed before contact Additional patient demographics of interest collected –Attending of record –Code status –Insurance –Education of family member –Diagnosis

29 S L I D E 28 Challenges Workflow –Time consuming –Harder once patient transferred out of ICU Resources –No dedicated research assistant –Not funded Technical Issues Family Response –~55% response rate for survivors –Interest

30 S L I D E 29 Benefits Fostering teamwork Involvement of bedside nurses in varied aspects of research Exploring our own strengths and weaknesses –Waiting room Feedback from families

31 S L I D E 30 Neurocritical Care Society 2013 conference abstract Satisfaction with Emotional Support Provided in a Neuroscience Intensive Care Unit Among Families of Surviving Patients with a Neurosurgeon Versus Neurointensivist as the Attending of Record

32 S L I D E 31 NCS abstract chart 1: Most common diagnoses NeurologyNeurosurgery Intracerebral hemorrhage (37.8%)Subarachnoid hemorrhage (50%) Ischemic stroke (24.3%)Traumatic brain injury (10%) Seizure (24.3%)Subdural hematoma (10%)

33 S L I D E 32 NCS abstract chart 2: Patient demographics Primary Service Age in years P=0.009 (SD) Length of Stay in days P=0.0001 (SD) Privately Insured in % p=0.004 (95% CI) Medicaid Insured in % p=0.03 (95% CI) Neurology69 (14.7)6.4 (4.4)54.1 (±16.06)10.8 (±10) Neurosurgery57.2 (12.8)13.4 (8.9)40 (±17.53)33.3 (±16.86)

34 S L I D E 33 NCS abstract figure: Emotional support Families reporting complete satisfaction with emotional support p = 0.04

35 S L I D E 34 NCS abstract: Conclusions In our NICU, neurosurgery families are more likely to be completely satisfied with the emotional support received from staff compared to neurology families. Questions: –Does a longer average length of stay allow NICU staff to build more of a relationship with neurosurgery families? –Do families feel more support with dual teams & attendings (NICU and neurosurgery) following? –Do neurosurgery families feel more support with a neurosurgery attending who does not change weekly (vs. rotating intensivists)?

36 S L I D E 35 Influence of year-round neurointensivist coverage p=0.0505

37 S L I D E 36 Influence of year-round neurointensivist coverage p=0.0568

38 S L I D E 37 Families with prior ICU experience vs. new to ICU Hwang DY, Robinson J, et al. Crit Care Med 2013;41(12):S830

39 S L I D E 38 Possible future directions Advantages of having ongoing ICU family satisfaction data collection: –Improved understanding of our local Neuro ICU at Yale Can help target ICU resources for quality improvement –Approval by Institutional Review Board allows for ongoing analysis and publication/presentation of observational data –Built-in pre- and post-assessments for any future interventions or change in practice that the team wishes to pursue –Available pilot data for future grant applications –Multidisciplinary ICU team building

40 S L I D E 39 Possible future directions Future analysis may focus more on surveys from families of those patients who have been made comfort measures only in the Neuro ICU –Of note, prior analyses have suggested that families of patients who pass away during ICU admission tend to report higher satisfaction than those of patient patients who survive to discharge We welcome collaboration with other ICUs collecting FS-ICU data –Increased observational power with larger number of surveys –Please e-mail us! Wall et al. Chest 2007;132:1425

41 S L I D E 40 Our team leaders at Yale Kelly Poskus, MS, RN Cindy Bautista, PhD, RN Jessica White, PA-C Meghan McAnaney, RN Anna Coppola, RN Maria Koursaris, RN Nathaniel Anderson, PA student Lavenita Smith, BA Kevin Sheth, MD, FCCM, FAHA Emily Gilmore, MD David Greer, MD, MA, FCCM, FAHA, FNCS Evie Marcolini, MD

42 S L I D E 41 Thank you! David Hwang, MD david.hwang@yale.edu Jennifer Robinson, APRN jennifer.robinson@yale.edu


Download ppt "Using the FS-ICU Instrument: Understanding and Improving Family Satisfaction in a Neuro ICU David Y. Hwang, MD Assistant Professor of Neurology Division."

Similar presentations


Ads by Google