More than half the families of mobile intensive care unit patients experience inadequate communication with physicians.

Abstract

This study aimed to assess comprehension by family members of the patient's severity in the prehospital setting. We conducted a cross-sectional study in four mobile intensive care units (ICUs, medicalized ambulances) in France from June to October 2012. Nurses collected data on patients, patient's relatives, and mobile ICU physicians. For each patient, one relative and one physician independently rated the patient's severity using a simplified version of the Clinical Classification of Out-of-Hospital Emergency Patients scale (CCMS). Relatives were also asked to assess their interview with the physician. The primary outcome was agreement between the relative's and physician's ratings of the patient's severity. Data were available for 184 patients, their relatives, and mobile ICU physicians. Full and partial agreement between relatives and physicians regarding the patient's severity was found for 79 (43%) and 121 (66%) cases, respectively [weighted kappa = 0.32 (95% confidence interval, CI, 0.23-0.42)]. Relatives overestimated the patient's severity assessed by the physician [6 (5-8) vs. 4 (3-7), p <0 .001]. The interview lasted 5 min (range 5-10) with the physician talking 80% (range 70-90) of that time. Overall, 171 (93%) and 169 (92%) relatives reported adequate interview time and use of understandable words by physicians. In multivariable analysis, the characteristics independently associated with increased odds of disagreement included (1) the relative not having a diploma (OR 4.88; 95% CI 1.27-18.70) and (2) greater patient severity (OR 6.64; 95% CI 1.29-16.71). More than half of family members reported inadequate comprehension of information on the patient's severity as communicated by mobile ICU physicians.