Written Care Summaries Facilitate Communication Between Families and Providers of ICU Patients: A Pilot Study

Abstract

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.

Interviews with primary care physicians identify unmet transition needs after ICU

“…Primary care physicians wanted better information sharing with patients and families about patient's ICU course and potential post-ICU complications [8,9], particularly when family involvement in the ICU was restricted [10][11][12]. Narrative, written, plain language information about a patient's ICU stay, available after discharge, which can be discussed with outpatient providers, may alleviate some of these problems [13,14].…”

Daily Written Care Summaries for Families of Critically Ill Patients: A Randomized Controlled Trial*

“…Because the written communication was personalized for the participant, inclusion of complex information was sometimes unavoidable. In our previous study, participants found the written summaries to be understandable (19). Participants were encouraged to discuss any aspect of the summary that they did not understand with the medical team.…”

“…In the outpatient setting, clinicians often provide written communication to the patient at the conclusion of the visit to improve comprehension and retention of medical information (17, 18). In a pilot study, we found that families of ICU patients who received daily written summaries reported improved understanding of the patient’s condition and improved communication with clinicians and other family members (19). The benefits of written updates were reported regardless of how frequently families visited in the ICU or interacted with the medical team.…”

More Documentation? Who Needs It?*

“…This process appears further augmented by cobinding of viral-ACE-2 complexes to either angiotensin-II type-1 receptors (AT1Rs) or vasopressin-V1 receptors (1). Additionally, multiple animal models consistently reported that proinflammatory AT1R signaling played a key mediating role in the development of experimental inflammatory lung injury (2). Further heightening interest in the RAS pertaining to COVID-19, there are already U.S. Food and Drug Administration-approved therapies that modulate the RAS including inhibitors of the ACE-1 enzyme (ACE-Is) as well as AT1R antagonists (AT1R blockade [ARB]) and agonists (synthetic angiotensin-II).…”

“…Both received the usual care, but the study group was also given the daily summaries. The summaries were created each afternoon by one investigator using a template they had previously piloted (2). The report summarized each of the patient’s problems, the etiology, whether there was improvement or decline, relevant diagnostic studies, and resultant therapies.…”