PLoS ONE (Jan 2019)

Measuring the quality of inpatient specialist consultation in the intensive care unit: Nursing and family experiences of communication.

  • Stephanie D Roche,
  • Alyse M Reichheld,
  • Nicholas Demosthenes,
  • Anna C Johansson,
  • Michael D Howell,
  • Michael N Cocchi,
  • Bruce E Landon,
  • Jennifer P Stevens

DOI
https://doi.org/10.1371/journal.pone.0214918
Journal volume & issue
Vol. 14, no. 4
p. e0214918

Abstract

Read online

RationaleCritically ill patients in the intensive care unit (ICU) often require the care of specialist physicians for clinical or procedural expertise. The current state of communication between specialist physicians and families and nurses has not been explored.ObjectivesTo document the receipt of communication by nurses and family members regarding consultations performed on their patient or loved one, and to quantify how this impacts their overall perceptions of the quality of specialty care.MethodsProspective survey of 60 adult family members and 90 nurses of 189 ICU patients who received a specialist consultation between March and October of 2015 in a single academic medical center in the United States. Surveys measured the prevalence of direct communication-defined as communication conducted in person, via telephone, or via text-page in which the specialist team gathered information about the patient from the nurse/family member and/or shared recommendations for care-and perceived quality of care.ResultsIn about two-thirds of family surveys (40/60) and one-half of nurse surveys (75/160), respondents had no direct communication with the specialist team that performed the consultation. Compared to nurses who had no direct communication with the specialists, those who did were 1.5 times more likely to rate the consultation as "excellent" (RR 1.48, 95% CI 1.2-1.8, pConclusionsMost ICU families and nurses have no interaction with specialist providers. Nurses' frequent exclusion from conversations about specialty care may pose safety risks and increase the likelihood of mixed messages for patients and families, most of whom desire some interaction with specialists. Future research is needed to identify effective mechanisms for information sharing that keep nurses and families aware of consultation requests, delivery, and outcomes without increasing the risk of mixed messages.