Family participation in ICU rounds may yield benefit, study finds

ICU rounds with family present were longer, but analyses suggested positive effects on relationship building, information gathering, patient and family education, team dynamics, and shared clinical decision making.

Family attendance in ICU rounds may increase their duration but improve communication, according to recent research.

In an observational study, researchers in Canada looked at the association between family participation in ICU rounds and rounding processes. Rounds were conducted by 33 attending physicians at seven hospitals in Canada, and 302 rounds involving 210 patients were observed. Patients' family members were defined as people participating on rounds who had any relation to the patient, including biological, legal, or emotional. Patient data were obtained from a regional database, while observational quantitative and qualitative data were collected via a separately tested form. A checklist assessing the quality of rounds on a 10-point scale, 1 being lowest and 10 being highest, was also completed. The study results were published online May 7 by Critical Care Medicine.

Thirty-eight days of observation were conducted between May 5, 2016, and Aug. 26, 2016. Family members attended 68 rounds (23%), were in the ICU during but did not attend 59 rounds (20%), and were not in the ICU during 175 rounds (58%). Family members who attended rounds were introduced 62% of the time and were given a summary of the discussion 87% of the time. The median duration of rounds was 20 minutes, 16 minutes, and 16 minutes, respectively (P=0.01). Discussion of prognostic information (35% vs. 36% vs. 36%; P=0.99) and bedside teaching (35% vs. 37% vs. 34%; P=0.88) did not differ among groups. No significant association was seen between the scored quality of rounds and family attendance or presence in the ICU (median score, 8 vs. 7 vs. 7, respectively; P=0.11). Qualitative analyses suggested that family attendance on ICU rounds may influence relationship building, information gathering, patient and family education, team dynamics, and shared clinical decision making.

The researchers noted that their study observed care only during rounds and that their results may reflect intrinsic bias and may not be generalizable. However, they concluded that while family attendance during ICU rounds may slightly increase their duration, it may help improve relationship building and promote shared decision making while having little effect on trainee teaching. “Family attendance in rounds enhances communication and is complementary to family conferences,” the researchers wrote. “Methods to identify individual family member preferences for participating in rounds, as well as barriers and facilitators to participation, warrants further study.”