Integration of Family into Medical Surgical Intensive Care Unit Multidisciplinary Rounds

Abstract

Problem: The Medical Surgical Intensive Care Unit (MSICU) of a community hospital lacked standard practices for involving family members in multidisciplinary rounds (MDR), despite evidence showing that family-centered care improves patient outcomes and overall satisfaction with care. The purpose of this DNP quality improvement project is to increase family engagement and empowerment in the MSICU by implementing evidence-based interventions over a 15-week period. Methods: The interventions included team member education on the benefits of involving caregivers in MDR, standard scripting for the MSICU team during rounds, and standard invitation scripting for caregivers with a focus on engagement in collaborating on the goals of care. These interventions were implemented in stages over a 15-week period, and post-discharge surveys to garner feedback from caregivers. Results: Compliance with inviting caregivers to MDR ranged from 71% to 100%, with an overall average of 82%. Family participation in rounds increased from a weekly average of 45% at the beginning of the pilot to 88% by the end of the pilot, with more than 80% participation consistently maintained for the final four weeks. Participation dipped in week 4, which corresponds with the lowest compliance rate for invitations to rounds (58%). Postimplementation, the overall satisfaction with care in the strongly agree category showed a 16% positive change compared to the pre-implementation group. Fewer caregivers slightly agreed (4% reduction), while more strongly agreed (10% positive change) regarding inclusion in decisions. Conclusions: Family involvement in the care of critically ill patients is critical, and familycentered care is a shared decision-making approach that emphasizes effective communication INTEGRATION OF FAMILY INTO ICU ROUNDS 3 and collaboration between the families and members of the care team. This QI project demonstrates that protocolized and structured caregiver invitation processes, and training for care team members on strategies for engaging family members can increase family participation in rounds and promote their inclusion in decision-making processes. These findings highlight the potential of protocolized processes and structured approaches in promoting family-centered care for critically ill patients. Future research could examine the effectiveness of these interventions on patient outcomes and overall satisfaction with care in larger and more diverse settings