Serafino LaGalbo
medical student
Rush Medical College, United States
Disclosure information not submitted.
Nicole Siparsky, MD, FACS
Chief, Acute Care Surgery & Surgical Critical Care
Rush University Medical Center
Chicago, Illinois
Disclosure information not submitted.
Title: Assessing Communication Quality in Provider-Decisionmaker Interactions in the Intensive Care Unit
Introduction:
Achieving successful shared decisionmaking and bidirectional communication in the intensive care unit (ICU) can be challenging. Many providers do not achieve proficiency in communication during training. A pilot study was designed to identify specific communication skill deficiencies through observation in the ICU.
Methods:
Seventeen providers were recruited from medical and surgical ICU services at Rush University Medical Center’s Adult ICU. This observational study evaluated providers’ communication skills across eight domains during encounters with decisionmakers: nonverbal communication, verbal communication, opening the discussion, gathering information, understanding the family’s perspective, sharing information, reaching agreements on problems and plans, and providing closure. When a provider engaged with a decisionmaker, an observer assessed their communication skills using an observational tool. Providers were aware they were being observed but were unaware of the skills being assessed.
Results:
Fourteen daytime conversations were observed by 3 attending physicians, 3 fellows, 6 residents, and 5 advanced practice providers. There was a significant average difference between communication skills of providers dedicated to working in the critical care setting (n=6) and providers who were not (n=8) in all encounters (p< .025). Scheduled goals-of-care conversations (n=7) had significantly higher average communication scores than unscheduled encounters (n=7), including family updates at bedside (p< .001). Providers were most proficient in building relationships through nonverbal and verbal communication (3.92, 4.08). Communication skills associated with provider-decisionmaker collaboration and understanding a decisionmaker's concerns were the least developed (3.15, 3.08).
Conclusion:
Providers commonly demonstrate superficial, unidirectional communication skill in communication with decisionmakers; they are less proficient at advanced communication skills. Providers should have more scheduled conversations focused on bidirectional communication at scheduled times, which is was most productive. A targeted curriculum addressing these areas may dramatically improve patient/decisionmaker/provider satisfaction.