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Audience Participation

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Presentation on theme: "Audience Participation"— Presentation transcript:

0 Jennifer Robinson, APRN
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

1 Audience Participation
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

2 Audience Participation
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

3 Lori Harmon, RRT, MBA Director, Program Development
Society of Critical Care Medicine Mount Prospect, IL Today’s webcast is supported by grant number R18HS 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.

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

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

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

7 Disclosures David Y. Hwang, MD Jennifer Robinson, APRN
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

8 ngm.nationalgeographic.com

9 Our talk today is re: a grassroots approach to examining the family experience in the ICU. How do you start research at your institution, perhaps with little or no external funding?

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

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

12 Importance of research on ICU family experiences
Crit Care Med 2007;35:605

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

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

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.

16 Rothen et al. Curr Opin Crit Care 2010;16:623

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

18 Johnson et al. Crit Care Med 1998;26:266

19 Wasser et al. Crit Care Med 2001;29:192

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 Wall et al. Crit Care Med 2007;35:271 Heyland et al. Crit Care Med 2002;30:1413

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 Wall et al. Crit Care Med 2007;35:271 Heyland et al. Crit Care Med 2002;30:1413

22 FS-ICU FS-ICU 24 items regarding general ICU care
Concern and caring of patient by members of ICU staff Management of pain Management of breathlessness Management of agitation Coordination of care Competence of nurses Competence of physicians Amount of health care received in ICU Interest in needs of family Emotional support for family Concern and caring of family members by members of ICU staff (courtesy, respect, compassion) Frequency of communication with ICU nurses with family Atmosphere in the ICU Atmosphere in the waiting room

23 FS-ICU FS-ICU 24 items regarding shared decision making Frequency of communication by ICU doctors Ease of getting information Understanding of information Honesty of information Completeness of information Consistency of information Inclusion in decision making Support during decision making Control over the care Time to address concerns and questions when making decisions 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

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

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

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

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

28 Challenges Workflow Resources Technical Issues Family Response
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

29 Benefits Fostering teamwork
Involvement of bedside nurses in varied aspects of research Exploring our own strengths and weaknesses Waiting room Feedback from families

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

31 NCS abstract chart 1: Most common diagnoses
Neurology Neurosurgery Intracerebral hemorrhage (37.8%) Subarachnoid hemorrhage (50%) Ischemic stroke (24.3%) Traumatic brain injury (10%) Seizure (24.3%) Subdural hematoma (10%)

32 NCS abstract chart 2: Patient demographics
Service (SD) (SD) (95% CI) (95% CI) Neurology 69 (14.7) 6.4 (4.4) 54.1 (±16.06) 10.8 (±10) Neurosurgery 57.2 (12.8) 13.4 (8.9) 40 (±17.53) 33.3 (±16.86)

33 NCS abstract figure: Emotional support
Families reporting complete satisfaction with emotional support p = 0.04

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)?

35 Influence of year-round neurointensivist coverage
p=0.0505

36 Influence of year-round neurointensivist coverage
p=0.0568

37 Families with prior ICU experience vs. new to ICU
Survey Variable Prior Exp None Frequency of communication by ICU doctors 65.0 69.2 Ease of getting information 82.9 84.6 Understanding of information 75.6 76.9 Honesty of information 82.5 80.8 Completeness of information Consistency of information 65.9 65.4 Inclusion in decision making 70.7 61.5 Support during decision making 53.7 52.0 Control over the care 58.5 54.2 Time to address concerns and questions when making decisions 94.4 92.0 Hwang DY, Robinson J, et al. Crit Care Med 2013;41(12):S830

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

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 us! Wall et al. Chest 2007;132:1425

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

41 Thank you! David Hwang, MD david.hwang@yale.edu
Jennifer Robinson, APRN


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