573: FAMILY COMMUNICATION IN THE ICU: CHALLENGES AND SOLUTIONS

Abstract

Introduction: The COVID-19 pandemic created major barriers to communication with patient families, impacting patient care and staff satisfaction. We surveyed an interprofessional group of medical intensive care unit (MICU) stakeholders to identify their concerns surrounding family communication and solicited recommendations for performance improvement. Methods: An anonymous survey was distributed electronically to 260 MICU physicians, advanced practice providers (APPs), nurses, and physical, occupational, and respiratory therapists, with a 1 week reminder. The results were analyzed using thematic analysis. Results: Thirty-nine participants (response rate 15%) completed the survey, providing 95 unique comments. Major themes included challenges created by visitor policy restrictions (providers unable to connect well with families by phone; families not understanding how to work video platforms; frequent misunderstandings); medical system distrust (antivaccine and overall hostility, unrealistic expectations, challenging treatment decisions); trainee communication concerns (lack of communication training, not seeing the “big picture”, nurse not knowing whether families were contacted/what was discussed), and A2F bundle failures (F component not organized, family updates too infrequent, distorted messages). This feedback prompted a quality improvement initiative to strengthen our family communication process. The responsible resident or APP is now encouraged to use a “Get to Know Me Board” to structure the collection of relevant social history with patient and family on admission, establishing an initial relationship and line of communication. Our rounding template was modified to discuss the family communication plan each day using a tiered structure (brief summary/introduction on admission; update; serious update/acute event; goals of care; transition to comfort) and clarify which team members will be present for the conversation. Afternoon rounds were also modified to routinely confirm successful family contact and address any concerns. Conclusions: We describe the results of our interprofessional survey to define the barriers to family communication during the COVID-19 pandemic, and process improvements in our MICU to make daily family involvement and contact feasible and efficient within our daily workflow.