Assessing Communication Quality in the Intensive Care Unit

Area of Science:

• Medical Communication
• Critical Care Medicine
• Shared Decision-Making

Background:

• Effective shared decision-making in intensive care units (ICUs) relies on two-way communication between providers and surrogate decision-makers.
• Communication skill deficiencies among ICU providers can hinder successful shared decision-making.

Purpose of the Study:

• To identify communication skill deficiencies in healthcare providers caring for critically ill patients in the ICU.
• To assess the quality of communication during decision-making conversations in the ICU.

Main Methods:

• An observational prospective study was conducted in a single urban academic medical center.
• Thirty-nine conversations between 23 ICU providers and 39 surrogate decision-makers were assessed using a customized observational tool.
• Communication skills evaluated included nonverbal and verbal communication, information sharing, and understanding the family's perspective.

Main Results:

• Less than half of the observed conversations achieved bidirectional communication proficiency.
• Communication skills did not vary significantly with provider experience or specialty.
• Scheduled conversations (n=14) demonstrated significantly higher average communication scores than unscheduled encounters (n=25).

Conclusions:

• ICU providers frequently engaged in superficial, unidirectional communication, lacking advanced skills for shared decision-making.
• Increasing the frequency of scheduled conversations is recommended to improve bidirectional communication.
• Targeted simulation-based training may enhance communication skills, leading to improved patient, decision-maker, and provider satisfaction.