The Surgical Intensive Care Unit Family Experience Survey: Integrating the Patient/Family Perspective Into ICU Quality Improvement

Abstract

Purpose: Quality initiatives in the Intensive Care Unit (ICU) often overlook the state of crisis that an ICU admission presents to patients and families. We surveyed patients and families to identify ICU strengths and weaknesses, and to guide interventions to improve ICU experience. Method(s): The Surgical Intensive Care Unit (SICU) is a 14 bed closed unit in a 1,171 bed tertiary hospital. Most patients are post-operative from various surgical specialties. Although all hospitalized patients receive a Press Ganey satisfaction survey, this survey rarely reflects the ICU experience. The SICU Family Experience Survey is a two page survey with Likert scale questions on perceptions of communication and care, and two open-ended questions on the 'best' and 'worst' aspects of SICU. The survey was developed with direct input from a multidisciplinary team of key stakeholders, including intensivists, critical care fellows, nurses, social work, spiritual care, and the palliative care team. Surveys are distributed to patients/families after transfer from the unit or after patients expire. Responses are quantitatively analyzed in an ongoing manner. Result(s): Over a six month study period, 331 surveys were distributed and 57 responses were received (17% response rate). A high level of satisfaction was reported with overall care in the SICU (mean 4.3/5, range 4.1-4.5). Responders identified areas for improvement, including spiritual support, social work, concerns about patient mobility, updates from doctors, and cleanliness of the unit. Multiple quality initiatives ensued. (1.) We improved spiritual and cultural care with daily chaplain rounds. (2.) Families now meet with critical care fellows daily and with the entire multidisciplinary critical care team within 48 hours. (3.) A nurse-led Progressive Mobility Project was implemented to promote early mobility. (4.) An ongoing initiative to reduce hospital-acquired infections in the unit includes enhanced daily cleaning of patient rooms, and continued education for staff and families. Clinical Implications: An ICU-focused survey can help address unmet needs by integrating the ICU patient/family perspective into the continuous improvement process.