Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
J Pain Symptom Manage. 2021 Sep;62(3):e112-e119. doi: 10.1016/j.jpainsymman.2021.04.008. Epub 2021 Apr 21.
In the name of public safety, a general suspension on hospital visiting was imposed in the U.K., prohibiting family and friends to visit hospitalized patients, even if they were critically ill.
we aimed to assess the impact of the FLT on the communication with patients' family and friends (PFF), especailly around end-of-life care, and their interaction with CC clinicians.
A retrospective, mixed-methods analysis of a family liaison team (FLT) formed by redeployed clinicians in critical care (CC) during the first surge of the 2020 COVID 19 pandemic.
The FLT was constituted predominantly of non-ICU consultants (30/39, 77%). Following two one-hourly webinars around basic communication skills, the FLT facilitated over 12,000 video and telephone calls with 172 patients' family and friends (PFF). The majority of the PFF interviewed were mostly, very or extremely satisfied with the frequency, ease, understanding, honesty, completeness, and consistency of the information provided. Approximately 5% of the interviewees reported to be slightly or very dissatisfied in one or more of the following 3 categories: frequency, consistency, and ease of getting the information. The thematic analysis identified 3 themes: 1) being there with/ for the patient; 2) breakdown in communication; 3) disbelief at the speed of deterioration. In 14.9% of cases there was documented discrepancy between the information transmitted by the CC team and that by the FLT, particularly around the severity of the patient's illness and their imminent death.
The formation of a dedicated FLT was feasible and associated with high levels of satisfaction by the PFF. Friction was created when communication was not consistent and did not convey the severity of the patient's condition, to prepare the PFF for a bad outcome.
为了公共安全起见,英国全面暂停了医院探视,禁止家属和朋友探望住院病人,即使他们病得很重。
评估 FLT 对与患者家属和朋友(PFF)沟通的影响,特别是在临终关怀方面,以及他们与 CC 临床医生的互动。
对在 2020 年 COVID-19 大流行第一波期间由重新部署到重症监护病房(CC)的临床医生组成的家庭联络团队(FLT)进行回顾性、混合方法分析。
FLT 主要由非 ICU 顾问组成(30/39,77%)。在进行了两次关于基本沟通技巧的每小时网络研讨会之后,FLT 与 172 名患者家属和朋友(PFF)进行了超过 12000 次视频和电话通话。接受采访的 PFF 中,大多数对提供的信息的频率、便利性、理解、诚实、完整性和一致性非常满意或极其满意。大约 5%的受访者在以下 3 个类别中的一个或多个方面表示略有或非常不满意:频率、一致性和获取信息的便利性。主题分析确定了 3 个主题:1)与患者同在;2)沟通中断;3)对病情恶化速度的难以置信。在 14.9%的情况下,CC 团队和 FLT 之间传输的信息存在差异,特别是在患者疾病的严重程度和他们即将死亡方面。
成立专门的 FLT 是可行的,并且与 PFF 的高度满意度相关。当沟通不一致且未能传达患者病情的严重程度时,就会产生摩擦,使 PFF 为不良结果做好准备。