Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
PLoS One. 2019 Apr 11;14(4):e0214918. doi: 10.1371/journal.pone.0214918. eCollection 2019.
Critically ill patients in the intensive care unit (ICU) often require the care of specialist physicians for clinical or procedural expertise. The current state of communication between specialist physicians and families and nurses has not been explored.
To document the receipt of communication by nurses and family members regarding consultations performed on their patient or loved one, and to quantify how this impacts their overall perceptions of the quality of specialty care.
Prospective survey of 60 adult family members and 90 nurses of 189 ICU patients who received a specialist consultation between March and October of 2015 in a single academic medical center in the United States. Surveys measured the prevalence of direct communication-defined as communication conducted in person, via telephone, or via text-page in which the specialist team gathered information about the patient from the nurse/family member and/or shared recommendations for care-and perceived quality of care.
In about two-thirds of family surveys (40/60) and one-half of nurse surveys (75/160), respondents had no direct communication with the specialist team that performed the consultation. Compared to nurses who had no direct communication with the specialists, those who did were 1.5 times more likely to rate the consultation as "excellent" (RR 1.48, 95% CI 1.2-1.8, p<0.001). Nearly 40% (22/60) of families knew so little about the consultation that they felt incapable of evaluating it.
Most ICU families and nurses have no interaction with specialist providers. Nurses' frequent exclusion from conversations about specialty care may pose safety risks and increase the likelihood of mixed messages for patients and families, most of whom desire some interaction with specialists. Future research is needed to identify effective mechanisms for information sharing that keep nurses and families aware of consultation requests, delivery, and outcomes without increasing the risk of mixed messages.
重症监护病房（ICU）中的危重症患者通常需要专科医生提供临床或操作方面的专业知识。目前尚未探讨专科医生与家属和护士之间的沟通现状。
记录护士和家属在其患者或亲人接受会诊时收到的沟通内容，并量化这对他们对专科护理质量的整体看法的影响。
对 2015 年 3 月至 10 月期间在美国一家学术医疗中心的 189 名 ICU 患者接受专科会诊的 60 名成年家属和 90 名护士进行前瞻性调查。调查衡量了直接沟通的发生率-定义为通过亲自、电话或文本页进行的沟通，在此过程中，专家团队从护士/家属那里收集有关患者的信息，和/或分享护理建议-以及感知的护理质量。
在大约三分之二的家属调查（40/60）和一半的护士调查（75/160）中，受访者与进行会诊的专科团队没有直接沟通。与没有与专家直接沟通的护士相比，有直接沟通的护士更有可能将会诊评为“优秀”（RR 1.48，95%CI 1.2-1.8，p<0.001）。近 40%（22/60）的家属对会诊知之甚少，以至于他们觉得自己无法评估。
大多数 ICU 家属和护士都没有与专科医生进行互动。护士经常被排除在专科护理讨论之外，这可能会带来安全风险，并增加患者和家属接收相互矛盾信息的可能性，而大多数患者和家属都希望与专科医生进行一些互动。需要进一步研究以确定有效的信息共享机制，使护士和家属了解会诊请求、实施和结果，而不会增加信息混乱的风险。
