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In the ICU, Patients' Relatives Often Mum About Care Concerns

THURSDAY, July 19, 2018 -- Many family members of intensive care unit (ICU) patients are reluctant to tell medical staff of worries about their loved one's care, a new study finds.

"Speaking up is a key component of safety culture, yet our study -- the first to our knowledge to address this issue -- revealed substantial challenges for patients and families speaking up during an ICU stay," said study co-author Dr. Sigall Bell. She's director of patient safety and discovery at OpenNotes at Beth Israel Deaconess Medical Center in Boston.

Bell and her team surveyed 105 families of patients admitted to an academic hospital's ICU between July 2014 and February 2015. The researchers also conducted an internet survey of 1,050 people with recent ICU experience.

Nearly two-thirds of ICU patients and families said they felt very comfortable talking to medical staff about medications, but only one-third said they felt comfortable bringing up concerns about hand hygiene or aggressiveness of care.

Only half the respondents said they were very comfortable asking for clarification about confusing or conflicting information or raising concerns about a possible error. The main reasons for their reluctance were fear of being labeled a "troublemaker," not knowing which person to talk to, and the medical team being very busy.

Younger people, men and those without personal experience in health care were less likely speak up, according to the researchers.

The study authors noted that the people included in the study were English-only speakers and many were college-educated and had connections to the health care industry, so the findings likely underestimate the problem.

The findings were published July 12 in the journal BMJ Quality and Safety.

"In the ICU setting in particular, families -- who are also among the most vigilant stakeholders -- may hold key information clinicians may have overlooked, and may be the first to detect a change in clinical status," Bell said in a Beth Israel news release.

"Our findings are important because true partnerships with patients and families may be limited if they don't feel supported to voice their concerns," she said.

"Our results highlight the need to explicitly support patients and families to speak up in real time about perceived errors. Hesitancy to do so represents a real safety gap," Bell said.

More information

The U.S. Centers for Disease Control and Prevention outlines how you can be a safe patient.

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Posted: July 2018


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