Written communication and the ICU team experience (WRITE): A pre-post intervention study

Abstract

ObjectiveFamilies of critically ill patients may benefit from receiving a written update of patient care each day. Our objective was to develop a system to facilitate care provider creation of written updates and to determine the effect of implementing this process on the care provider experience. DesignThe experiences of ICU care providers (nurses, advanced practice providers, and physicians) were measured monthly during a 3-month pre-intervention and a 3-month intervention period. During the intervention period, written updates were sent to families each day and posted in the electronic medical record. Study investigators assisted by editing and distributing the written communication to families. SettingAn urban academic medical center in the United States. Main outcome measuresNurse-Physician Collaboration Scale (NPCS) and Maslach Burnout Inventory (MBI). ResultsOver the 3-month intervention period, care providers created written communication for families of 152 patients (average 5 ICU days per family). NPCS scores among the 65 participating care providers were significantly lower, indicating greater collaboration during the intervention vs. pre-intervention period: 49.9 (95 % CI 46.4–53.6) vs. 55.4 (95 % CI 51.5–59.3), p = 0.002. MBI scores were similar during the intervention vs. pre-intervention periods. A subset of care providers participated in individual interviews. Care providers reported that the process of creating written communication was acceptable and had clear benefits for both families and the medical team. ConclusionsUse of written communication as a supplement to verbal communication improves collaboration among ICU care providers without affecting symptoms of burnout. Implications for practiceWe created a system to facilitate written communication with ICU families that was acceptable to care providers and improved aspects of their experience. In the future, use of written communication can be enhanced with refinements to the process that reduce the time spent creating written updates while highlighting the benefits to families and care providers.