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Open Access Highly Accessed Research

Surgical intensive care unit clinician estimates of the adequacy of communication regarding patient prognosis

Rebecca A Aslakson1*, Rhonda Wyskiel2, Dauryne Shaeffer2, Marylou Zyra2, Nita Ahuja3, Judith E Nelson4 and Peter J Pronovost1

Author Affiliations

1 Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA

2 Department of Surgical Nursing, The Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287, USA

3 Department of Surgery and Oncology, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA

4 Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine and Hertzberg Palliative Care Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY, 10029, USA

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Critical Care 2010, 14:R218  doi:10.1186/cc9346

Published: 29 November 2010

Abstract

Introduction

Intensive care unit (ICU) patients and family members repeatedly note accurate and timely communication from health care providers to be crucial to high-quality ICU care. Practice guidelines recommend improving communication. However, few data, particularly in surgical ICUs, exist on health care provider opinions regarding whether communication is effective.

Methods

To evaluate ICU clinician perceptions regarding adequacy of communication regarding prognosis, we developed a survey and administered it to a cross section of surgical ICU nurses, surgical ICU physicians, nurse practitioners (NPs), and surgeons.

Results

Surgeons had a high satisfaction with communication regarding prognosis for themselves (90%), ICU nurses (85%), and ICU physicians and NPs (85%). ICU nurses noted high satisfaction with personal (82%) and ICU physician and NP (71%) communication, but low (2%) satisfaction with that provided by surgeons. ICU physicians and NPs noted high satisfaction with personal (74%) and ICU nurse (88%) communication, but lower (23%) satisfaction with that provided by surgeons. ICU nurses were the most likely (75%) to report speaking to patients and patient families regarding prognosis, followed by surgeons (40%), and then ICU physicians and NPs (33%). Surgeons noted many opportunities to speak to ICU nurses and ICU physicians and NPs about patient prognosis and noted that comments were often valued. ICU physicians and NPs and ICU nurses noted many opportunities to speak to each other but fewer opportunities to communicate with surgeons. ICU physicians and NPs thought that their comments were valued by ICU nurses but less valued by surgeons. ICU nurses thought that their comments were less valued by ICU physicians and NPs and surgeons.

Conclusions

ICU nurses, surgeons, and ICU intensivists and NPs varied widely in their satisfaction with communication relating to prognosis. Clinician groups also varied in whether they thought that they had opportunities to communicate prognosis and whether their concerns were valued by other provider groups. These results hint at the nuanced and complicated relationships present in surgical ICUs. Further validation studies and further evaluations of patient and family member perspectives are needed.