Rounding Summaries for Families of Critically Ill Patients

Rush

Status: Completed

Conditions: Communication; Intensive Care Unit Syndrome; Acute Respiratory Failure

Treatments: Behavioral: Rounding Summary

Study type: Interventional

Funder types: Other

Identifiers

NCT03969810

19042604

Details and patient eligibility

About

Many patients in intensive care units (ICUs) rely on family members or surrogates to make medical decisions on their behalf. One of the recommended ways to improve a surrogate's experience is to invite him or her to participate in daily, multidisciplinary ICU rounds. In practice, this is often a challenging way for clinicians to engage with the patient's surrogates.

Surrogates of non-decisional ICU patients will be randomized to receive a written rounding summary every day or every other day that the patient is in the ICU. The summary will be organized as follows for each of the most important ICU problems: 1) Description of the problem, 2) Ways the ICU team is addressing the problem i.e. consultations, diagnostic tests, and treatments. 3) An assessment of whether the problem is improving or worsening.

The investigators hypothesize that surrogates who receive written rounding summaries will be more satisfied with ICU care than surrogates who receive usual care. Satisfaction will be measured by the Critical Care Family Needs Inventory (CCFNI) questionnaire.

Enrollment: 252 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Patients in the adult Medical and Cardiac ICUs at Rush University Medical Center will be prospectively screened.

Inclusion criteria (Patient characteristics required for surrogate inclusion) At least one of the following

• The patient has required invasive or non-invasive mechanical ventilation for at least three consecutive days.
• The patient has an expected in-hospital mortality rate of at least 25% according to the primary ICU physician.

Exclusion criteria (Patient characteristics that will exclude surrogates from study enrollment):

• The patient possesses decisional capacity at the time of enrollment.
• The patient has required invasive or non-invasive mechanical ventilation for more than the previous 14 days
• The patient is expected to die or transition to comfort care within the next 48 hours based on ICU physician estimate.
• The patient is expected to be liberated from mechanical ventilation (if applicable) or discharged from the ICU within the next 24 hours.
• There is no identifiable surrogate.
• The patient is member of a vulnerable population i.e. pregnant, prisoner.
• The ICU physician refuses permission to approach surrogates for consent

The investigators will hand out fliers that describe the study to surrogates of patients who are expected to meet the above criteria. Surrogates can ask the nurse to contact the lead investigator if they are interested in learning more about the study. If no surrogate is present prior to the patient meeting the inclusion criteria, the investigators will attempt to contact the surrogate by phone to provide information on the study.

One surrogate will be approached for informed consent and enrolled based on the following criteria.

Inclusion criteria for surrogate decision maker:

• Age ≥ 18 years old
• Self-identified as participating directly in health care decision making for the incapable patient

Exclusion criteria for surrogate decision makers:

• The surrogate does not agree to participate in study procedures (surveys, interviews)
• The surrogate needs translation assistance because of poor English fluency
• The surrogate has history of a clinically important neurological disorder (e.g., dementia)

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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252 participants in 2 patient groups

Rounding Summary

Experimental group

Description:

Surrogates who are assigned to the intervention group will receive a written rounding summary every day or every other day that the patient is in the ICU. The summary will be organized as follows for each of the most important ICU problems: 1) Description of the problem, 2) Ways the ICU team is addressing the problem i.e. consultations, diagnostic tests, and treatments. 3) An assessment of whether the problem is improving or worsening. For patients assigned to the intervention group, the investigators will forward the previous day's summary to the ICU nurse at the beginning of each day shift. After participating in morning rounds, ICU nurses will be asked to modify the summary based on the plan for the day. Nurses will be asked to use the written summary to guide communication with surrogates that day.

Treatment:

Behavioral: Rounding Summary

Usual Care

No Intervention group

Description:

Usual ICU care