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Patient and Family Performance Measures

Patient-and-Family centered performance measures focused on actionable processes of care for persistent or chronic critical illness.

Submitted by Louise Rose, RN, BN, ICU Cert, MN, PhD, FAAN

Advances in technology and adoption of efficacious interventions into clinical practice have improved intensive care unit (ICU) survival rates. However, approximately 10% of critically ill adults experience persistent or chronic critical illness. This results in protracted ICU length of stay, ongoing dependency on resource-intensive therapies, and long-term physical and cognitive deficits, complicating and prolonging recovery. Family members of these patients also experience enormous emotional distress.  Patients with persistent or chronic critical illness have unique and complex needs requiring a change in the clinical management plan and overall goals of care to a focus on rehabilitation, symptom relief, and in some cases, end-of-life care. Existing ICU care quality and tools, such as daily rounding checklists, are not sufficiently inclusive of actionable processes of care (i.e., care we can change) appropriate to patients with persistent or chronic critical illness. Further, these measures or tools have not been developed with the patient and family perspectives at the forefront.  Our project, partly funded by the Ontario Respiratory Care Society/The Lung Association, will address this gap by identifying care priorities and developing a tool to help us deliver care to improve the ICU experience for these patients and their family members.

In this project we will answer the following research questions:

  1. What does the evidence base tell us about actionable processes of care for patients with persistent or chronic critical illness?
  2. What do survivors of persistent or chronic critical illness and their family recall about their ICU experience that can identify actionable processes of care of importance to them?
  3. What do ICU clinicians perceive to be important for the delivery of high-quality care to these patients and their family members?
  4. Which processes of care and outcomes are prioritized by key stakeholders including survivors of persistent or chronic critical illness, their family members, and the clinicians that treat them?

To answer these research questions, we have completed a systematic review of published evidence relating to our population of interest. This review has produced 36 actionable processes of care of potential relevance. We are now conducting narrative-based, loosely structured video interviews of ICU survivors and family members to help us identify ICU processes of care of importance to them. These interviews will be combined to generate a touch-point video – a research tool that helps identify aspects of care relevant to care recipients. This video will be shown to clinicians. Following, interviews will be conducted with them to identify aspects of care important to clinicians. We then intend to conduct a consensus ranking exercise to identify 8 to 10 actionable processes of care to be embedded into a daily rounding checklist for ICU patients with a length of stay over 7 days. Next steps of our research program will be to determine the feasibility and pilot test implementation of this daily rounding tool. If you know of an ICU survivor or family member that might be interested in participating in an interview or consensus exercise, or if you as a clinician would like to participate, for further information please contact Dr. Louise Rose – louise.rose@utoronto.ca.

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