Communication in Intensive Care Group “Communication” D Biarent, L Huygens, L Bossaert, De Jongh, Y Somers, M Laurent, M Slingemeyer

Goals of communication  Quality of communication between HCP and family could play a role on recovery of patients Tilly, AJM 2000  Family want to be informed and to participate to medical decision Molter DCCN, 1994;13:2-3 Jacob Am J Crit Care, 1998;7:30-36  Family are waiting honest information Harvey Crit Care Med, 1993;4:  No rational behind exclusion of the family during care of the patient Robinson Lancet, 1998;352:614-17

Query Ideally : query directed to patient and/or family Questionnaire directed to ICU directors  Only on voluntary basis  Profile of all Belgian units  Indirect tools to measure level of information and communication  Sensitisation

Query  Evaluation of modalities of reception of a patient and his family in ICU Architecture for reception/admission Schedules and organisation for visiting ICU patient Premises

 Communication (indirect evaluation) Identification of HCP Modalities of information of relatives Delivery of bad news/prognosis Modalities of information of GP  Team Psychological support Education Transmission of information Files DNR order

Results  Number of ICU 39 / 134 (28.3 %)  Number of beds 637  Visits limited to less than 2 h/day  Children admitted from 10 y of age  Family is accompanied by HCP during admission/resuscitation  Relative not allowed to witness resuscitation / procedure

 Interviews with family are frequent but not structured  Possibility for family to stay during night are scarce  Bad news delivery

Structured interview with relatives: who speaks Intensivists82% Dr in charge 63% Specialists50% Psychologist13% Resident39% Nurse63% Cultural repres26% GP26% Also present

Structured interview with relatives: teaching & discussion Discussion/communication after bad news delivery Unformal: 63% Organised during staff meeting: 66% Psychiatrist liaison meeting: 8% Written report: 55%

Team psychologic help / support Individual systematic: 5% Individual on request: 29% Group systematic: 11% Group on request: 24%

Patient’s files  Fully computerised files : 30%  Partially computerised : 41%  Limited access for some HCP categories : 91%  Nursing file access for relatives : 54%  Patient file access for relatives : 59%

Death of patients  Family members are informed that death of their relative is near in 98%  Relatives are present during the death event in 84%  Relatives may stay longer in privacy with the deceased in 24%

Conclusion  Obvious concern from majority of ICU to communicate with relatives (dedicated HCP, frequent information during resuscitation, HCP identification, oldest children accepted)  Presence during procedure and resuscitation, length of visit, possibility to stay with the patient, visit of youngest children, bad news delivery modalities and teaching are subject to possible improvement  Architectural limitation impairs confidentiality  Lack of psychological support