(653) Patient and Patient-Family Engagement in Intensive Care Unit Disposition: Mixed-Methods Study

Introduction:

Introduction: The transfer of ICU patients to lower acuity settings is a major transition in care. We evaluated how patient and patient-family engagement in ICU transfer/discharge can be improved.

Methods:

Methods: We conducted a mixed-methods study in ICUs in Regina General Hospital (Regina, Canada) from May-June 2023. The ICUs conduct daily multidisciplinary rounds and have a 24-hour family presence model. We recruited ICU survivors (and their family members) who were listed for transfer/discharge. Semi-structured interviews were conducted. Thematic analysis of audio transcripts was performed with NVivo.

Results:

Results: Thirty-six patients were screened over a six-week period with 13 participants interviewed. Seven (54%) were patients and six (46%) were substitute-decision makers. Only two (15%) were related to the same patient. Participants had a mean age 49.4 years (SD 16.6). Six (46%) were female, six (46%) were male, and one (8%) preferred not to answer. Patients had a median Charlson score 3 (IQR 2-5) and SOFA 10 (IQR 6-11). In terms of engagement, 46% felt engaged with ICU transfer and 85% felt engaged with ICU care overall. Those who felt engaged reported feeling informed and consulted. Communication with nurses and conduct of daily rounds were the largest factors in engagement. Lack of discussion regarding transfer led to reports of feeling less engaged. Other factors included a lack of expectation to be informed/consulted due to the acuity of the patient, as well as the patient’s condition impairing them from having an active role in care. Suggestions to improve engagement included introducing oneself and talking through tasks when performing patient care, filling out whiteboards in patient rooms, checking for patient and patient-family understanding during rounds, informing patients and patient-families prior to transfer, and addressing expectations/concerns regarding changes in level of care.

Conclusions:

Conclusion: Patient and patient-family engagement in ICU transfer/discharge was driven by feeling informed and consulted about the decision to transfer/discharge. Barriers to engagement include poor communication with staff and discussion surrounding the transfer or transfer process. Addressing these processes may improve patient and patient-family engagement.