A Communications Bundle to Improve Satisfaction for Critically Ill Patients and Their Families: A Prospective, Cohort Pilot Study.

Abstract

Communication skills training with simulated patients is used by many academic centers, but how to translate skills learned in simulated settings to improve communication in real encounters has not been described. We developed a communications bundle to facilitate skill transfer from simulation to real encounters and improve patient and/or family satisfaction with physician communication. We tested the feasibility of its use in our hospital's medical intensive care unit (MICU). This prospective cohort 2-week feasibility study included patients admitted to the MICU with APACHE IV predicted mortality >30% and/or single organ failure. The communications bundle included simulation communication training for MICU physicians, scheduling a family meeting within 72 hours of MICU admission, standardized pre- and post-meeting team huddles with the aid of a mobile app to set an agenda, choose a communication goal, and get feedback, and documentation of meeting in the electronic medical record. The intervention group receiving the communications bundle was located in a geographically separate unit than the control group receiving standard of care from MICU physicians who had not received training in the communications bundle. Patient satisfaction surveys were given within 48 hours of the family meeting and scores compared between the two groups. We also compared trainee self-perceived communication preparation. The intervention group (N = 15) scored significantly higher on satisfaction than the control group (N = 16) (P = 0.018). Intervention group trainees reported improvement in self-perceived communication preparation. Use of the communications bundle proved feasible in the MICU and suggests association with improved patient satisfaction and trainee self-perception of communication preparedness.