Huffines Meredith, Johnson Karen L, Smitz Naranjo Linda L, Lissauer Matthew E, Fishel Marmie Ann-Michelle, D'Angelo Howes Susan M, Pannullo Diane, Ralls Mindy, Smith Ruth
Crit Care Nurse. 2013 Oct;33(5):56-69. doi: 10.4037/ccn2013354.
Background Survey data revealed that families of patients in a surgical intensive care unit were not satisfied with their participation in decision making or with how well the multidisciplinary team worked together. Objectives To develop and implement an evidence-based communication algorithm and evaluate its effect in improving satisfaction among patients' families. Methods A multidisciplinary team developed an algorithm that included bundles of communication interventions at 24, 72, and 96 hours after admission to the unit. The algorithm included clinical triggers, which if present escalated the algorithm. A pre-post design using process improvement methods was used to compare families' satisfaction scores before and after implementation of the algorithm. Results Satisfaction scores for participation in decision making (45% vs 68%; z = -2.62, P = .009) and how well the health care team worked together (64% vs 83%; z = -2.10, P = .04) improved significantly after implementation. Conclusions Use of an evidence-based structured communication algorithm may be a way to improve satisfaction of families of intensive care patients with their participation in decision making and their perception of how well the unit's team works together.
调查数据显示，外科重症监护病房患者的家属对他们参与决策的情况以及多学科团队的协作情况不满意。目的：制定并实施基于证据的沟通算法，并评估其对提高患者家属满意度的效果。方法：一个多学科团队制定了一种算法，其中包括在患者入院后24小时、72小时和96小时进行的一系列沟通干预措施。该算法包括临床触发因素，若出现这些因素则会使算法升级。采用基于过程改进方法的前后对照设计，比较算法实施前后家属的满意度得分。结果：实施后，参与决策的满意度得分（45%对68%；z = -2.62，P = 0.009）以及医疗团队协作情况的满意度得分（64%对83%；z = -2.10，P = 0.04）均显著提高。结论：使用基于证据的结构化沟通算法可能是提高重症监护患者家属对其参与决策的满意度以及对科室团队协作情况认知度的一种方法。
