No abstract

Families of critically ill patients frequently experience anxiety, depression, and acute stress. 1 To ease this burden, clinicians encourage families to play an active role in a patient's care by visiting the hospital and engaging with the ICU team. 2,3 During the COVID-19 pandemic, however, many hospital systems have prohibited family visitation to limit the spread of the disease. 4 Little is known about the family experience during the COVID-19 pandemic. We hypothesized that the lack of direct contact with the patient and the medical team would amplify the burden of anxiety, depression, and acute stress among families of ICU patients.

To determine the effect of daily written updates on the satisfaction and psychologic symptoms of families of ICU patients.DESIGN: Randomized controlled trial.

OBJECTIVES: ICU providers may invite families to participate in daily rounds to inform them of the patient’s condition and to support their emotional well-being. Daily written summaries of care may provide complementary benefits. DESIGN: Qualitative interviews with surrogates of ICU patients who received daily written summaries of care. SETTING: Single, urban academic medical center. PATIENTS/SUBJECTS: A convenience sample of 30 surrogates of nondecisional, medical ICU patients. INTERVENTIONS: Daily written summaries detailed each of the patient’s main ICU problems, the presumed causes of each of the problems, and the medical team’s plan to address each of the problems for each ICU day. MEASUREMENTS AND MAIN RESULTS: There were four ways that written summaries affected the participant’s experience: 1) providing clarity to participants regarding the patient’s condition, 2) facilitating participant understanding of the patient’s clinical course, 3) facilitating communication between participants and medical providers, and 4) facilitating communication between participants and other family members. Overarching themes were that summaries were understandable, had appropriate level of detail, and added value to the ICU experience. CONCLUSIONS: In this pilot study, family members had positive impressions of receiving daily written summaries of care. Further study is needed to determine the extent to which written communication may affect family and patient outcomes.

Family members of non-decisional, critically-ill patients often report inadequate communication with the clinicians. A recommended way that clinicians can improve engagement with the patient's family is to invite them to participate in Intensive Care Unit (ICU) rounds. Providing families with written summaries of rounds is a novel approach to family engagement, which may be particularly beneficial for family members who are unable attend rounds or who do not understand the information that is presented. METHODS: From September 2018 to April 2019, an availability sample of 24 surrogates of non-decisional, critically ill patients at high risk for in-hospital mortality were prospectively enrolled. Participants received written documents in the afternoon each ICU day, detailing each of the patient's main ICU problems, the presumed cause of the problem, and the medical team's approach to the problem. Families were asked to share summaries with all family members that were involved in the patient's care. Subjects participated in a semi-structured qualitative telephone interviews after they had received at least three summaries. Sixteen phone interviews were transcribed. Two trained coders used thematic content analysis to understand the impact of the intervention on the family experience. RESULTS: Subjects received an average of 7 summaries (SD 3, range 3-15) during the patient's ICU stay. Four themes emerged that revealed the impact of written summaries on the family experience: Two themes dealt with knowledge and two themes dealt with communication. 1) Written summaries made the patient's medical problems and plan for the day easier to understand. 2) By comparing summaries from day to day, families could understand whether the patient was making progress. 3) There was an improved understanding of the patient's medical problems that allowed for better communication with the patient's medical team. 4) Sharing summaries improved communication among all of the patient's family members. CONCLUSIONS: In this pilot study, family members believed that by receiving daily written summaries, they understood the patient's medical issues better and had an easier time communicating with clinicians and other family members. Implementation of written summaries may be an important way to supplement the information presented to families during ICU rounds.