Hospital supervisors improve patient communication, reduce call button use and increase satisfaction scores with new bedside whiteboards. Reach out to the author: contact and available social following information is listed in the top-right of all news releases.
How social care staff can improve their communicationThe United Kingdom Homecare Association has published a guide to communication for social care workers.
There are widespread concerns about communication and support for patients and families, especially when they face clinical uncertainty, a situation most marked in intensive care units (ICUs).
Our design was a phase I-II study following the Medical Research Council Guidance for the Development and Evaluation of Complex Interventions and the (Methods of Researching End-of-life Care (MORECare) statement. PACE is a feasible interventional tool that has the potential to improve communication, information consistency, and family perceptions of symptom control. BackgroundCommunication and support for patients and their families are of central concern in healthcare, and yet too often are poorly addressed, especially at times of rapid changes in health status and in clinical uncertainty. There was a general perception among family members that symptoms were well controlled, and that timely action was taken when the patient appeared to be distressed. The importance of being able to ask questions and have them answered was emphasized by family members, but there was also a sense that family members felt they were responsible for getting information by asking the right questions of the right people. Meeting individual wishes, expectations and spiritual needs that vary between different social and cultural groups [21a€“24]. Abbreviations: ICU intensive care unit, LCP Liverpool Care Pathway for the care of the dying patient. Therefore, our study aimed to adapt or develop and evaluate a new evidence-based tool to better meet patient and family communication and holistic care needs in ICU. Components of the study by phase of the Medical Research Council guidance on the development and evaluation of complex interventions, showing how the different components combine to inform the next phase in the sequence. SettingThe study took place in two adult ICUs (general medical and surgical) in a 950-bed south London teaching hospital, serving a socially and culturally heterogeneous population. ResultsPhase IWe first interviewed 13 family members, representing 11 patients, and conducted observations on the care of these patients. Members of the hospital palliative care team and researchers were present for 3a€“4 hours each day to introduce PACE and answer questions to foster collaboration between ICU and palliative care staff. The next section of PACE gives space for a continuing log of any communication update.The final section of PACE provides a list of useful resources - as a prompt to seek additional support for patients and families.
Abbreviations: ICU intensive care unit, PACE Psychosocial Assessment and Communication Evaluation. Qualitative interviews with families and observation post-PACE implementationIn total, 11 interviews were undertaken representing 10 patients (in 7 of these cases there was a completed PACE in the clinical records). Small groups (brown bag lunches, skip level meetings, small group updates, etc.) can provide a format for personalized leadership communication. It can be difficult to manage and maximize employee attendance of executive communication opportunities, particularly if you are offering multiple, smaller group sessions and some staff are a higher priority that others in terms of attendance. Customized meeting invites The SnapComms desktop RSVP alert allows you to customize a meeting invite with multiple time slots and venues. Invite high priority staff first Targeting features allow you to target high priority staff groups with invites first.
Ask questions beforehand The RSVP alert tool allows you to include explanatory text and to ask staff to choose the leadership communication session they want to attend. Outlook integration When employees reply, the desktop RSVP tool provide the option for employees to enter the appointment in their Outlook calendar. Collect questions and issues beforehand Use surveys, polls and discussion forums to collect questions and identify key issues prior to a face-to-face executive communication. Don't have all the answers - keep conversations going If executives have all the answers during a town hall meeting or smaller face-to-face session, it can make it look contrived. Executive blogs and staff discussion forums Social media can be a great way support leadership communication, to make senior managers more accessible and create a feeling of openness and transparency.
Encourage feedback Use polls and surveys to allow staff to provide feedback, ask further questions and to measure the effectiveness of the leadership communication session.
Screensaver reminders can provide a good way to promote executive communication activities such as a monthly hot line, webinar or town hall meeting.
User generated newsletters Use an internal newsletter tool to allow employees (including the executive team) to submit short news articles into that internal newsletter.
We custom print each special board design in HD full color and offer optional individual printed room and bed ID numbers. Krapf, Inc., designs, manufactures and direct-markets over 2,300 steel whiteboard kits, calendar boards, maps, and other information display systems for hospitals, industry and government. Something as simple as a raise of the eyebrow, a smile or a frown can convey a clearly understood message from one person to another.Good communication is vital in social care. Saying hello and goodbye are equally as important as asking the service user for information about their condition, day, feelings, or consent to care and treatment. Therefore, we aimed to develop and evaluate an interventional tool to improve communication and palliative care, using the ICU as an example of where this is difficult. In two ICUs, with over 1900 admissions annually, phase I modeled a new intervention comprising implementation training and an assessment tool. It is completed within 24 to 48 hours of admission, and covers five aspects (key relationships, social details and needs, patient preferences, communication and information status, and other concerns), followed by recording of an ongoing communication evaluation. The intensive care unit (ICU) is one setting in which patientsa€™ circumstances can change rapidly. Particular words stood out for some people, reinforcing the need for careful choice of the words in this context.
Preferences of family members for involvement varied; generally most of them wanted information about the process but not greater input (some preferring less). Although not everyone was aware of it, the LCP was reported to be used particularly on the medical ICU.
The importance of understanding family structures was emphasized by some family members, along with ensuring that information about the patient was given to the correct family members. Phase I explored concerns using interviews of staff and families, and observed the process of care for them, leading to tool development.


The two ICUs have 32 beds, and an annual intake of more than 1,900 admissions (1,800 excluding readmissions), associated with 250 to 300 deaths in the ICU.
Four the patients were women, age range 23 to 87 years) with diagnoses including infection, injury, and malignancy (Table 2). These results also emphasized the need for psychosocial assessment and communication to be tailored to individual needs, with documentation of who had received what information when teams changed (Table 1) to improve continuity of care. Additional file 3 shows the PACE in full.The PACE is logged by the admitting key worker, usually an ICU nurse. Multiple Outlook appointments can be ineffective and confusing and additional resources may be required to manage appointments and send out confirmations. This allows you to keep groups small and maximize the chances that staff can attend a leadership communication session. Then, once key people have a chance to register for an executive communication, open up the remaining opportunities for other employees. This helps ensure that the tone and content of the meeting hit the mark and executives are prepared with the information they need to address issues and engage staff.
It can even work in the leader's favor if they dona€™t have all the answers prepared and say, "I dona€™t know. Corporate Screensaver Messaging on employee screensavers can dramatically increase levels of employee participation.
Click through hyperlinks mean this can be a great way to spark interaction and encourage employees to visit the CEO blog. Using whiteboards at patient bedside has become a best practice” says a Nurse Manager from a Long Island hospital. Printing is heat-fused directly into our porcelain-like steel surface designed to stay like-new for a lifetime of around the clock hospital use. It may be the difference between the person feeling they have been treated with dignity and respect, and received high quality care and treatment, or not.When caring for someone it is important that you communicate as clearly and truthfully as possible. We conducted a literature review, qualitative interviews, and focus groups with 40 staff and 13 family members. Although the central goal in the ICU is to preserve or extend life, the nature of illness or trauma means that more than one in five people admitted to an ICU die there [1]. It was thought to be useful for patients on a longer dying trajectory and for those discharged to the wards, to ensure continuity of care.
Phase II tested the feasibility and effects of the tool on staff and families (see Figure 1). However, although documentation was needed, staff wanted to ensure any tool was a€?paper-lighta€™ and did not result in large amounts of extensive form filling.
The goal of developing the tool was to improve assessment and communication for all patients in the ICU, not just those at the end of life.
Other aspects measured also showed a trend towards improvement in the PACE group, although this did not reach statistical significance.
One interviewee (in the PACE group) highlighted the value of being able to plan a meeting with the doctor out of hours.
When we do have face-to-face executive communication it needs to be as effective as possible and maximize the return on the investment. You can write on them with the dry-erase markers and use their carefully selected magnets and accessories for posting information with out messy tapes and tacks. However, there are times when this might not be possible, but understanding some of the barriers that prevent communication from taking place may improve our communication skills.
This resulted in the new tool, the Psychosocial Assessment and Communication Evaluation (PACE). A post-implementation survey of 95 ICU staff found that 89% rated PACE assessment as very or generally useful. Many (36 to 70%, depending on type of the ICU) deaths occurring in ICUs are preceded by a decision to limit or withhold life-sustaining treatment [1, 2]. There were concerns about its length, but also some support because it included components of basic nursing care. We used the Methods of Researching End-of-life Care (MORECare) statement of good practice to aid our procedures [48] (for compliance details, see Additional file 1). Communication was a central theme, influencing issues such as decision-making and family support.
Thus PACE sought to improve care for patients who may deteriorate, and equally those who may recover.
The rationale for keeping PACE in the clinical record is to avoid miscommunication and improve continuity by holding psychosocial information in one place.
With their hand-smooth SlimLyne aluminum truss frame and patented dislodgement-resistant wall-mounting hangers, you can lift them off the wall for portable hand-posting and quickly re-hang them.
Phase II evaluated the feasibility and effects of PACE, using observation, record audit, and surveys of staff and family members. Of 213 family members, 165 (78%) responded to their survey, and two-thirds had PACE completed.
Recent initiatives, such as care pathways, have sought to improve end-of-life care, but these have focused on patients who are already known to be dying [3]. The ICUs service the local population and also provide support to regional trauma, neurosciences, transplantation, and cardiac services for the southeast of England. The goal is that the assessment prompts changes in actions by staff in response to the assessment findings.
To overcome this, try to use different communication methods and repeat the communication several times. There is a need to develop a wider range of interventions before this point to improve symptom control, communication, and support in ways appropriate both for patients who may recover, and for those who deteriorate or die [4]. Of the admissions, 75% are white British, and 25% are non-white British (80% black Caribbean or African, and 20% from other groups).
The statistical tests used on quantitative data were t-tests (for normally distributed characteristics), the I‡2 or Fishera€™s exact test (for non-normally distributed characteristics) and the Manna€“Whitney U-test (for experience assessments) to compare the characteristics and experience for cases with and without PACE recorded.
This is particularly important for the growing number of people who experience co-morbidities and because of the advances in medical treatments, both making prognostication ever more difficult.


There may be communication impediments such as poor hearing, poor vision and speech impediments such as aphasia (inability to speak) that may make communication very difficult.
Palliative care is an area of healthcare focused on relieving and preventing the suffering of patients with complex needs and their families, including physical, emotional, communication, social, and spiritual aspects. Semi-structured interviews were conducted face-to-face with a lead family member (for one patient, with two family members at the familya€™s request), and were recorded and transcribed verbatim. The research process and feedback of the results led to much discussion about decision-making, communication, and end-of-life issues. Check to see what other communication methods might be appropriate, for example, photographs, pictures, or sign language. Unlike much hospice care, palliative care is relevant at all stages of illness, including during curative treatment and at the end of life.Summary of existing literature on levels of need and interventionsWe searched electronic databases to identify literature on the needs of patients and families in the ICU and potential interventions. A topic guide was developed from a literature review, initial observations, and discussion with service users. In addition, there was increased input from the palliative care team on the units and psychosocial support by different providers, including chaplaincy and the palliative care team, as a consequence of the heightened awareness and identification of needs through the use of PACE.PACE was launched in the ICU after the three piloting phases. Systematic reviews and research have highlighted concerns about support for patients and families, symptom control, communication, and decision-making, especially regarding when to stop invasive treatments, and attention to individual wishes and to dignity, respect, and peace in the ICU (Table 1) [5a€“25].
We conducted focus groups with ICU doctors, nurses, and other professionals involved in the delivery of care to patients and their families and palliative care practitioners to explore the experience and views of an end-of-life care pathway for the intensive care setting, using a topic guide. Further revisions were undertaken on two occasions, at 6 weeks and 4 months after the original launch, to address concerns and suggestions by staff.
To overcome this, ensure all the required information is available, or if the answer is not known, find out the answer and communicate this back to the person as soon as possible. Staff participants were purposively selected to gain perspectives from a broad range of health care professionals, taking into account differences in age, gender, length of time working on the units, and nursing grade.Results were presented to a working group of clinicians from ICU and palliative care, who developed the new interventional tool, termed the Psychosocial Assessment and Communication Evaluation (PACE). Interventions include having a palliative care team presence at family meetings and on ward rounds, providing education and support for ICU staff, making recommendations for symptom management, and directly supporting patients and families in shared care and implementation of care pathways.
An audit of the completion of PACE logs of 81 consecutive patients found that half (41) were completed within 24 hours, and the remainder within 48 hours of admission to ICU.
Empathy is an important aspect of caring for people and staff should try to understand things from the other person’s point of view.
We conducted non-participant observation during and after implementation, and collected completed and de-identified copies of PACE logs. Culture and languageTranslation services may be required but beware of using family members to translate as there may be problems with them communicating difficult issues, or issues they don’t want their relative to know about, resulting in them giving different or inaccurate information.
A randomized, controlled, feasibility study evaluating palliative care teams in an Australian ICU found no significant differences in satisfaction with care of families and staff or in length of stay, but the study was underpowered (10 patients randomized to each arm) [28]. We conducted qualitative interviews with families, broadly similar in characteristics to those interviewed before PACE was introduced.
AngerIf someone is angry about their condition or diagnosis it may be difficult to talk to them about their proposed care and treatment. A prospective, observational study of a structured palliative care intervention for trauma patients in the ICU [29] applied the intervention to all trauma patients because of the high mortality (15 to 20%).
Anger is a difficult situation to overcome except by acknowledging that it exists and offering to help when the person is ready to receive it.Verbal communication comes in two forms, written and oral. The study found that Do Not Resuscitate orders, life support withdrawal, and discussions of symptom management occurred significantly earlier, with no change in mortality rate, but the effect on families or patients was not assessed. A staff questionnaire survey was emailed to all ICU doctors and nurses, with two reminders. The survey asked about any difficulties experienced in completing the PACE, views of its use, and its effect on care.We attempted to survey one family member for each patient cared for on the ICU during the period of PACE implementation and use.
Family members were identified and given information about the study, and then on a subsequent visit were given the questionnaire. We excluded family members whom the staff deemed were too distressed to complete the questionnaire, family members of patients admitted for less than 12 hours or family members who had visited the ICU fewer than 3 times. The questionnaire had mainly closed questions with a few open questions, and was administered by the researchers, unless the family wished to self-complete.
It included the 24-item Family Satisfaction in the Intensive Care Unit questionnaire (FS-ICU) [50], validated to measure family member satisfaction with a patienta€™s admission in ICU.
We were able to compare the characteristics and experiences reported in cases when a PACE had (n = 88) and had not (n = 42) been completed (note there were instances when we could not match to PACE completion because of confidentiality and the nature of responses).
We compared responses according to whether a PACE was or was not completed for the corresponding patient.Analysis and sample sizesAll data were anonymized.
Qualitative data were analyzed using the framework approach [51], which enabled the systematic identification of themes both from questions and from emergent issues.
This was undertaken independently by two researchers (CS, CR), with the Project Advisory Group agreeing the thematic framework. For the survey of family members we used t-tests (for normally distributed characteristics), I‡2 or Fishera€™s exact test (for non-normally distributed characteristics), and the Manna€“Whitney U-test (for experience assessments) to compare the characteristics and experience of families for cases that had PACE completed with those that had not. When equality of variances was not assumed adjusted values are given (t, degrees of freedom, P, 95% CI for mean differences). All tests were two-sided.Qualitative samples aimed to capture different groups in terms of age, gender, length of time in ICU, diagnosis, and social and cultural background, and thus capture the range of views. However, if we assume 20% (a likely level based on previous research) of families have serious concerns, we needed 76 respondents to achieve a margin of error of 9% (95% confidence interval).
Therefore, we estimated that 150 participants would provide reasonable descriptive accuracy and allow for subgroup analysis (sample stratified by age, gender, ethnicity, and disease).
For both the qualitative and quantitative data, the samples aimed to be sufficient for preliminary exploration, as we were not formally testing PACE but to exploring its potentially beneficial or adverse effects.



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