Long-term persistence of quality improvements for an intensive care unit communication initiative using the VALUE strategy

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• 作者：Nicholas G. Wysham ; MD^a ; ^{Nicholas.Wysham@gmail.com" class="auth_mail} ; Richard A. Mularski ; MD ; MSHS ; MCR^b ; ^c ; ^{Richard.A.Mularski@kpchr.org" class="auth_mail} ; David M. Schmidt ; MD ; PhD^b ; ^{David.M.Schmidt@kp.org" class="auth_mail} ; Shirley C. Nord ; MSW^b ; ^{Shirley.C.Nord@kp.org" class="auth_mail} ; Deborah L. Louis ; RN ; MSN ; CCRN^b ; ^{Deborah.L.Louis@kp.org" class="auth_mail} ; Elizabeth Shuster ; MS^c ; ^{Elizabeth.Shuster@kpchr.org" class="auth_mail} ; J. Randall Curtis ; MD ; MPH^d ; ^{JRC@u.washington.edu" class="auth_mail} ; David M. Mosen ; PhD ; MPH^c ; ^{David.M.Mosen@kpchr.org" class="auth_mail}
• 关键词：Communication ; Family satisfaction ; Quality of health care ; End-of-life care ; Critical care ; Outcome and process assessment(health care)
• 刊名：Journal of Critical Care
• 出版年：June 2014
• 年：2014
• 卷：29
• 期：3
• 页码：450-454
• 全文大小：404 K

文摘

Communication in the intensive care unit (ICU) is an important component of quality ICU care. In this report, we evaluate the long-term effects of a quality improvement (QI) initiative, based on the VALUE communication strategy, designed to improve communication with family members of critically ill patients.

Materials and Methods

We implemented a multifaceted intervention to improve communication in the ICU and measured processes of care. Quality improvement components included posted VALUE placards, templated progress note inclusive of communication documentation, and a daily rounding checklist prompt. We evaluated care for all patients cared for by the intensivists during three separate 3 week periods, pre, post, and 3 years following the initial intervention.

Results

Care delivery was assessed in 38 patients and their families in the pre-intervention sample, 27 in the post-intervention period, and 41 in follow-up. Process measures of communication showed improvement across the evaluation periods, for example, daily updates increased from pre 62% to post 76% to current 84% of opportunities.

Conclusions

Our evaluation of this quality improvement project suggests persistence and continued improvements in the delivery of measured aspects of ICU family communication. Maintenance with point-of-care-tools may account for some of the persistence and continued improvements.