Families Perception, Knowledge, and Psychological Stress of Transitions of Care From the ICU: Improving Transition of Care

Abstract

SESSION TITLE: Patient Safety and Quality Improvement SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 31, 2017 at 02:45 PM - 04:15 PM PURPOSE: Transition of care from the intensive care unit is fundamental for patient recovery and overall outcomes. This complex process requires strong coordination between healthcare providers and patients’ families. Inadequate communication can hinder patient’s safety during transition of care. Our objective is to assess the quality of continuity of care by analyzing family perceptions, education, and their psychological stress during the process. METHODS: From April 2016 to March 2017, a quality improvement project was conducted in a long-term acute care (LTAC) facility, Kindred Hospital South Florida. Individuals who had family members admitted to the LTAC were asked to fill out a 15-item questionnaire upon admission. Participants were asked to recall their experiences with preceding intensive care unit (ICU) hospitalization. Questionnaires were collected within one week after LTAC admission. RESULTS: 50 participants admitted to LTAC were enrolled in the project. 44 participants returned a completed questionnaire. Among them, 25%(11/44) expected their family member to completely recover, 73%(32/44) expected recovery with disabilities, and 2.2%(1/44) expected no recovery. Concerning length-of-stay in LTAC, 6/44 participants (13.6%) expected discharge within one week, 8/44(18.2%) expected 1 to 2 weeks, 8/44(18.2%) expected 3 to 4 weeks, and 22/44(50%) were unaware of the time. Prior to ICU discharge, 13/44(29.5%) of participants expected transfer to LTAC, while 31/44(70.4%) did not. Regarding knowledge of care, two-thirds (66%) of participants did not report a satisfactory level of knowledge, equipment or medical services their family member required. 11/44(25%) of participants did not receive family support throughout ICU admission. 22/44(54.5%) of participants self-reported anxiety, 11/44(25%) depression and 14/44(31.8%) insomnia. CONCLUSIONS: Perception of patients’ prognosis, disposition, and length-of-stay varies significantly among patients’ families. Perception diversity could precipitate families’ emotional distress and challenge effective communication. Establishing optimal channels of communication to overcome barriers and empower patients’family could improve the quality of transitions of care in the intensive care setting. CLINICAL IMPLICATIONS: This is the first study addressing transition of care from the ICU from patients’ family perspective. It identifies communication gaps in perception and knowledge of transition of care. It also identifies an added physiological distress to patient’s family during the process. This study could help to develop further research aiming to improve the transition of care out the ICU to LTAC. DISCLOSURE: The following authors have nothing to disclose: Chi Chan Lee, Osman Perez, Alwiya Saleh, Armando Cabrera, Nillian Zamot, Mauricio Danckers, Gustavo Ferrer No Product/Research Disclosure Information