Effect of intensive care environment on family and patient satisfaction: a before–after study

Jongerden, Irene P.; Slooter, Arjen J. C.; Peelen, Linda M.; Wessels, Hester; Ram, Colette M.; Kesecioğlu, Jozef; Schneider, Margriet M E; Dijk, Diederik van

doi:10.1007/s00134-013-2966-0

Cited by 84 publications

(100 citation statements)

References 42 publications

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“…Of the 21 studies, 16 were based on single publications from a single cohort 17,[38][39][40][41][42][55][56][57][72][73][74][75][78][79][80] and five were based on multiple publications from overlapping cohorts. 9,10,53,54,[59][60][61][62][63][64][65][66][67][68][69][70][71]76,77 These studies are reported between 2002 and 2014.…”

Section: Settingmentioning

confidence: 99%

“…Most of the studies were based in North America -the USA (n = 9) 53,54,[59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][76][77][78][79][80] and Canada (n = 3) 9,10,56,74 -with other studies based in Greece (n = 2), 41,42 Switzerland (n = 2), 17,55 Germany (n = 1), 39 Israel (n = 1), 57 the Netherlands (n = 1), 75 the Philippines (n = 1) 38 and Turkey (n = 1). 40 Nine studies were single centre, with the remainder being multicentre, ranging from 2 to 23 centres.…”

Section: Settingmentioning

confidence: 99%

See 1 more Smart Citation

Family-Reported Experiences Evaluation (FREE) study: a mixed-methods study to evaluate families’ satisfaction with adult critical care services in the NHS

Wright

Walmsley

Harvey

et al. 2015

Health Serv Deliv Res

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BackgroundTo improve care it is necessary to feed back experiences of those receiving care. Of patients admitted to intensive care units (ICUs), approximately one-quarter die, and few survivors recollect their experiences, so family members have a vital role. The most widely validated tool to seek their views is the Family Satisfaction in the Intensive Care Unit questionnaire (FS-ICU).ObjectivesTo test face and content validity and comprehensibility of the FS-ICU (phase 1). To establish internal consistency, construct validity and reliability of the FS-ICU; to describe family satisfaction and explore how it varies by family member, patient, unit/hospital and other contextual factors and by country; and to model approaches to sampling for future use in quality improvement (phase 2).DesignMixed methods: qualitative study (phase 1) and cohort study (phase 2).SettingNHS ICUs (n = 2, phase 1;n = 20, phase 2).ParticipantsHealth-care professionals, ex-patients, family members of ICU patients (n = 41, phase 1). Family members of ICU patients (n = 12,303, phase 2).InterventionsNone.Main outcome measuresKey themes regarding each item of the 24-item FS-ICU (FS-ICU-24) (phase 1). Overall family satisfaction and domain scores of the FS-ICU-24 (phase 2).ResultsIn phase 1, face validity, content validity and comprehensibility were good. Adaptation to the UK required only minor edits. In phase 2, one to four family members were recruited for 60.6% of 10,530 patients (staying in ICU for 24 hours or more). Of 12,303 family members, 7173 (58.3%) completed the questionnaire. Psychometric assessment of the questionnaire established high internal consistency and criterion validity. Exploratory factor analysis indicated new domains:satisfaction with care,satisfaction with informationandsatisfaction with the decision-making process. All scores were high with skewed distributions towards more positive scores. For family members of ICU survivors, factors associated with increased/decreased satisfaction were age, ethnicity, relationship to patient, and visit frequency, and patient factors were acute severity of illness and invasive ventilation. For family members of ICU non-survivors, average satisfaction was higher but no family member factors were associated with increased/decreased satisfaction; patient factors were age, acute severity of illness and duration of stay. Neither ICU/hospital factors nor seasonality were associated. Funnel plots confirmed significant variation in family satisfaction across ICUs. Adjusting for family member and patient characteristics reduced variation, resulting in fewer ICUs identified as potential outliers. Simulations suggested that family satisfaction surveys using short recruitment windows can produce relatively unbiased estimates of average family satisfaction.ConclusionsThe Family-Reported Experiences Evaluation study has provided a UK-adapted, psychometrically valid questionnaire for overall family satisfaction and three domains. The large sample size allowed for robust multilevel multivariable modelling of factors associated with family satisfaction to inform important adjustment of any future evaluation.LimitationsResponses to three free-text questions indicate the questionnaire may not be sensitive to all aspects of family satisfaction.Future workReservations remain about the current questionnaire. While formal analysis of the free-text questions did not form part of this proposal, brief analysis suggested considerable scope for improvement of the FS-ICU-24.Study registrationCurrent Controlled Trials ISRCTN47363549.Funding detailsThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Settingmentioning

confidence: 99%

Section: Settingmentioning

confidence: 99%

Family-Reported Experiences Evaluation (FREE) study: a mixed-methods study to evaluate families’ satisfaction with adult critical care services in the NHS

Wright

Walmsley

Harvey

et al. 2015

Health Serv Deliv Res

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“…In this issue of ICM, Irene Jongerden and her colleagues [1] present the results of a before-and-after study that explores the effect of a change in ICU environment on family and patient satisfaction. Family satisfaction was measured by the FS-ICU [2][3][4], a much used and previously validated tool, while patient satisfaction was elicited by using an adapted version of this questionnaire.…”

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confidence: 99%

Family-centered ICU care may be good for everyone

Hartog

Jensen

2013

Intensive Care Med

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In this issue of ICM, Irene Jongerden and her colleagues [1] present the results of a before-and-after study that explores the effect of a change in ICU environment on family and patient satisfaction. Family satisfaction was measured by the FS-ICU [2-4], a much used and previously validated tool, while patient satisfaction was elicited by using an adapted version of this questionnaire. A similar approach has been taken previously by a Swiss group [5]. The structural intervention was a move of the ICU to new premises, which entailed a bundle of changes. New rooms were single-bed rooms, noise-reduced, with increased privacy, more space around each bed, natural lighting and windows with a view. There were also changes in workflow, visual display of other patients via the bedside monitor, and medication prepared in a satellite pharmacy, thereby reducing medication errors. In addition, the number of family rooms was increased, and facilities for families were improved. In association with these changes, both overall family and patient satisfaction increased significantly. This study is important for several reasons: It is one of the first to show improvement in family satisfaction with an intervention (suggesting responsiveness to change), and it is one of the first that documents an effect of changing the ICU environment on families. Interestingly, satisfaction of families and patients increased not only in relation to the ICU environment, but to the ICU experience, specifically staff behavior toward families and patients. In the new ICU, families stated that staff provided better emotional support, acted with more courtesy, respect, and compassion, and were more willing to answer questions. Patients found that staff treated them with more courtesy, compassion, and respect, individual staff members were better recognizable, and management of pain improved (Fig. 1). These findings suggest that structural changes may have indirectly affected ICU care by improvement of team collaboration and support of family-and patient-centered behavior. Possibly working conditions were made easier for staff by providing more space around the bed and improving workflow. Reducing noise levels may also lower stress for nurses and physicians. It may also be easier for staff to provide emotional support to patients and families who are well satisfied with the environment. Alternatively, it is also possible that the improved environment influenced patient and family perceptions of these other aspects of care through a ''halo effect '' [6]. Nonetheless, these evaluations of diverse aspects of care improved.Defining indicators to improve quality of care for critically ill patients is an important issue [7]. Increasingly, family satisfaction with care is becoming an accepted measure of quality of care [8], and measurement of family or patient satisfaction in the ICU is already recognized as a quality indicator in several countries, including the Netherlands [9]. The study by Jongerden et al. provides further data to support that family-and p...

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“…Because salient terms reflect factors important in shaping perceptions and experiences related to the ICU, these findings identify themes most likely to be associated with the satisfaction of patients and patients' family members with the ICU experience and care. [33][34][35][36][37] These themes can be used as a starting point for future studies to further refine the meaning of the themes to patients and patients' family members and ways to measure the themes.…”

Section: Discussionmentioning

confidence: 99%

Defining the Medical Intensive Care Unit in the Words of Patients and Their Family Members: A Freelisting Analysis

Auriemma¹,

Lyon²,

Strelec³

et al. 2015

American Journal of Critical Care

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Effect of intensive care environment on family and patient satisfaction: a before–after study

Cited by 84 publications

References 42 publications

Family-Reported Experiences Evaluation (FREE) study: a mixed-methods study to evaluate families’ satisfaction with adult critical care services in the NHS

Family-Reported Experiences Evaluation (FREE) study: a mixed-methods study to evaluate families’ satisfaction with adult critical care services in the NHS

Family-centered ICU care may be good for everyone

Defining the Medical Intensive Care Unit in the Words of Patients and Their Family Members: A Freelisting Analysis

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