Background

In intensive care units (ICUs), the quality of communication with families is a key point in the caregiver-patient-family relationship. During the COVID-19 pandemic, hospital visits were prohibited, and many ICUs implemented a daily telephone call strategy to ensure continuity of communication with patients’ families.

Objective

To assess how family members and health care providers perceived this communication strategy.

Methods

The study was conducted in a 45-bed ICU during the COVID-19 pandemic. Communication with families consisted of a single daily telephone call from the senior physician in charge of the patient to the patient’s surrogate decision maker. Satisfaction was qualitatively assessed via an anonymous online questionnaire with open-ended questions.

Results

Participants completed 114 questionnaires. Forty-six percent of surrogate decision makers stated that the key medical messages were understandable, but 57% of other family members expressed that the frequency of information delivery was insufficient. Fifty-six percent of the physicians described the practice as functional for the organization of the unit. Among health care providers other than physicians, 55% felt that not having to interact with families decreased their emotional load and 50% mentioned saving time and the absence of task interruptions as positive aspects.

Conclusion

Fixed-time, daily telephone calls in the ICU allowed satisfactory transmission of information between physicians and surrogate decision makers, as perceived by both parties. However, the telephone-based communication strategy could still be improved.

Family members and friends play an important role as surrogate decision makers (SDMs) for critically ill patients in the intensive care unit (ICU).1  Patients with COVID-19 and acute respiratory distress are often sedated for weeks to facilitate mechanical ventilation.2  In the past, families had been able to visit patients in ICUs at any time of the day and receive updates from hospital staff, but during the height of the pandemic, visitors were not permitted access to hospitals because of a national lockdown.

To adapt to this sudden change, most ICUs instituted a single daily telephone call between a senior physician and the SDM. Because of this change, the relationship between the physician and the SDM was only verbal, and other family members and other health care providers were excluded from the discussion. We thought it important to evaluate the perceptions of this practice. Few data have been published on communication between ICUs and patients’ relatives during the peak of the COVID-19 outbreak. The satisfaction of the patient’s family is an important indicator of quality of care in the ICU,3  and families’ satisfaction in the context of the COVID-19 crisis has not yet been evaluated. The objective of this study was to use a qualitative approach to describe the perceptions of patients’ families and health care providers of the practice of using a single daily telephone call for communication in the context of the COVID-19 pandemic.

Methods

A survey was conducted during a 10-day period via an anonymous online questionnaire. During that 10-day period, the 45 ICU beds of our department were occupied with the same patients, all of whom were sedated and receiving mechanical ventilation. Each patient’s care was managed by 4 senior physicians alternating day and night shifts. The survey (LimeSurvey) was sent by email to the SDM and other family members of all 45 patients as well as the physicians and other health care providers who provided their care. The survey contained open-ended questions (Table 1) about the participants’ perception of the telephone calls as the only way of delivering patient-related information. Participants’ responses were analyzed through a thematic analysis according to the recommendations of Thomas4  regarding inductive coding.

Table 1

Survey questions

Survey questions
Survey questions

Results

A total of 340 emails with links to the questionnaire were sent from April 16 to April 26, 2020, and 114 questionnaires were fully completed and analyzed. The response rates were 58% for SDMs, 78% for physicians, and 20% for other health care providers (nurses, nursing assistants, and residents). The demographic characteristics of respondents are presented in Table 2. The relationship of the SDM to the patient was spouse (38.5%), adult child (26.9%), parent (3.8%), sibling (19.2%), or friend/other (11.5%). One-third of the respondents acknowledged the highly specific context of the pandemic and the constraints that it imposed on the hospital staff. Forty-six percent of the SDMs stated that the key medical messages were understandable. The frequency of information delivery was described as a negative aspect by 22% of participants, including 57% of other family members, who considered the daily telephone call to be “insufficient” as the only way to get news. Thirteen respondents (3 SDMs, 5 other family members, and 5 other health care providers) suggested that 2 telephone calls a day would be helpful; 2 respondents (1 SDM and 1 other health care provider) suggested that 3 telephone calls a day would be helpful.

Table 2

Demographic characteristics of participants and free responses about the communication strategy in the intensive care unit

Demographic characteristics of participants and free responses about the communication strategy in the intensive care unit
Demographic characteristics of participants and free responses about the communication strategy in the intensive care unit

Regarding communication within the family, 86% of the other family members described positively the transmission of information by the SDM to other family members. However, 62% of SDMs reported difficulties regarding this task, including 38% who mentioned the burden of responsibility and 12% who reported that they were overwhelmed by the numerous requests for news that they had to handle. Eighty-three percent of physicians described good communication with the SDM, although 72% reported a degraded quality of interpersonal interaction with the telephone versus in-person communication. Other health care providers evaluated this communication method as positive because it simplified the organization of care: 50% mentioned that telephone calls performed exclusively by physicians was time-saving and prevented iterative workflow interruptions. In addition, 55% of other health care providers felt that not having to interact with families decreased their emotional load, but 67% reported relational loss.

Discussion

Many participants mentioned that the regular telephone calls helped to structure their daily routine during the lockdown. The emotional burden mentioned by SDMs highlights the need to systematically offer psychological support. Our study assessed whether a single daily telephone call communication strategy was perceived as satisfactory by SDMs and met their needs and expectations. Most SDMs and caregivers (physicians and other health care providers) suggested that a minimum of 2 telephone calls per day would be helpful, an idea that has support in the literature.5  Some respondents suggested using devices for videoconferencing. However, video interfaces and smartphones are not suitable for unconscious ICU patients, and such technology is expensive and would need to be secure in terms of data protection before being implemented in an ICU environment.6  The communication strategy used during this study relieved caregivers from answering incessant phone calls from families, and their responses showed that this was valuable to them. This element is particularly important in the case of a highly contagious disease, given that telephones are potential vectors7  in the spread of COVID-19. In addition to this, a reduction in task interruptions mitigates common patient hazards, especially in ICU settings.8 

Conclusion

Fixed-time, daily telephone calls in the ICU allowed satisfactory transmission of information between physician and SDM, as perceived by both parties. Should this strategy be necessary again in the future, possible improvements include greater frequency of calls and the use of videoconferencing.

ACKNOWLEDGMENTS

We thank the teams of the anesthesia and intensive care departments of the Georges Pompidou European Hospital in Paris, France. The study was approved by the research ethics committee of Paris Descartes University (IRB 0001202044). The data used and analyzed during the study are available from the corresponding author on reasonable request.

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Footnotes

FINANCIAL DISCLOSURES

None reported.

 

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