Kodali Sashikanth, Stametz Rebecca, Clarke Deserae, Bengier Amanda, Sun Haiyan, Layon A J, Darer Jonathan
Division of Clinical Innovation,Geisinger Health System,Danville,Pennsylvania.
Center for Health Research,Geisinger Health System,Danville,Pennsylvania.
Palliat Support Care. 2015 Aug;13(4):961-7. doi: 10.1017/S1478951514000650. Epub 2014 Jul 10.
Family-centered care provides family members with basic needs, which includes information, reassurance, and support. Though national guidelines exist, clinical adoption often lags behind in this area. The Geisinger Health System developed and implemented a program for reliable delivery of best practices related to family communication to patients and families admitted to the intensive care unit (ICU).
Using a quasiexperimental study design and the 24-item Family Satisfaction in the Intensive Care Unit questionnaire (FSICU-24©) to determine family satisfaction, we measured the impact of a "family communication pathway" facilitated by tools built into the electronic health record on the family satisfaction of neurosurgical patients admitted to the ICU.
There was no statistically significant difference noted in family satisfaction as determined by FSICU-24 scores, including the Care and Decision Making constructs between the pre- and post-intervention pilot population. The percentage of families reporting the occurrence of a family conference showed only minimal improvement, from 46.5% before to 52.5% following the intervention (p = 0.565). This was mirrored by low numbers of documented family conferences by providers, suggesting poor uptake despite buy-in, use of electronic checklists, and repeated attempts at education.
This paper reviews the challenges to and implications for implementing national guidelines in the area of family communication in an ICU coupled with the principles of clinical reengineering.
以家庭为中心的护理为家庭成员提供基本需求，包括信息、安慰和支持。尽管有国家指南，但该领域的临床应用往往滞后。盖辛格医疗系统开发并实施了一项计划，以便将与家庭沟通相关的最佳实践可靠地提供给入住重症监护病房（ICU）的患者及其家属。
采用准实验研究设计，并使用24项重症监护病房家庭满意度问卷（FSICU - 24©）来确定家庭满意度，我们测量了电子健康记录中内置工具所推动的“家庭沟通途径”对入住ICU的神经外科患者家庭满意度的影响。
根据FSICU - 24评分确定的家庭满意度，包括干预前后试点人群在护理和决策制定方面，没有观察到统计学上的显著差异。报告召开家庭会议的家庭比例仅略有改善，从干预前的46.5%提高到干预后的52.5%（p = 0.565）。这与提供者记录的家庭会议数量较少情况相呼应，表明尽管有支持、使用电子检查表并多次进行教育尝试，但采用率仍然很低。
本文回顾了在ICU中实施家庭沟通领域国家指南所面临的挑战和影响，以及临床再造的原则。
