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Multidisciplinary team training to enhance family communication in the ICU
David J Shaw1, Judy E Davidson, Renée I Smilde
11Department of Graduate Medical Education, Scripps Mercy Hospital, San Diego, CA. 2Scripps Clinical Research Center, La Jolla, CA. 3Employee Assistance Program, Scripps Mercy Hospital, San Diego, CA. 4Nursing Excellence and Advanced Practice, Scripps Mercy Hospital, San Diego, CA.
Objectives:
Current guidelines from the U.S. Society for Critical Care Medicine state that training in "good communication skills...should become a standard component of medical education and ... available for all ICU caregivers". We sought to train multidisciplinary teams of ICU caregivers in communicating with the families of critically ill patients to improve staff confidence in communicating with families, as well as family satisfaction with their experiences in the ICU.
Design:
Pre- and postintervention design.
Setting:
Community hospital medical and surgical ICUs.
Patients:
All patients admitted to ICU during the two time periods.
Intervention:
Ninety-eight caregivers in multidisciplinary teams of five to eight individuals trained in a standardized approach to communicating with families of ICU patients using the Setup, Perception, Invitation, Knowledge, Emotions, Strategy (or Subsequent) (SPIKES) protocol followed by participation in a simulated family conference.
Measurements:
Staff confidence in communicating with family members of critically ill patients was measured immediately before and 6-8 weeks after training sessions using a validated tool. Family satisfaction using seven items measuring effectiveness of communication from the Family Satisfaction in the ICU (24) tool in surveys received from family members of 121 patients admitted to the ICU before and 121 patients admitted to the ICU after trainings was completed.
Main Results:
Using 46 matched pre- and postsurveys, staff confidence in communicating with family members of critically ill patients increased significantly (p < 0.001) in each of 21 separate measures. Family satisfaction with communication showed significant (p < 0.05 or better) improvement in three of seven individual items compared with those same items pretraining. There was no decline in any individual item.
Conclusions:
A simple intervention resulted in improvement in staff confidence, as well as in multiple measures of family satisfaction with communication. This intervention is easily reproduced.
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