Telemedicine Enhances Communication in the Intensive Care Unit

Patients admitted to the Intensive Care Unit (ICU) are critically ill and often at extremely high risk of death. These patients receive aggressive interventions to prolong their lives. Despite these measures, many patients still succumb to their illness. Although ICU physicians are good at predicting which patients have a high risk of mortality, they are still offering interventions that do not prolong life, but potentially cause more suffering at the end of life. This is because there is a lack of high quality and early communication to discuss prognosis and establish patients\u27 goals of care. This gap in communication is even more profound when patients are transferring from rural hospitals to busy tertiary care centers. This dissertation discusses the utilization of tele-video conferencing to enhance early communication with family members/loved ones of critically ill patients prior to their transfer from a rural hospital to a tertiary care center. It begins with a description of telemedicine and its uses in the ICU to date. Chapter 2 discusses the poor prognoses of patients receiving high intensity interventions such as cardiopulmonary resuscitation (CPR). The extremely dismal outcomes underscore the importance of early, thorough discussions regarding prognosis and goals of care in these patients. The next chapter describes a pilot study utilizing telemedicine to conduct formal unstructured telemedicine conferences with family members prior to transfer. This study demonstrated that palliative care consultations can be provided via telemedicine for critically ill patients and that adequate preparation and technical expertise are essential. Although this study is limited by the nature of the retrospective review, it is evident that more research is needed to further assess its applicability, utility and acceptability. Chapter 4 describes an investigation into the barriers and facilitators of conducting conferences via telemedicine and the perceptions of clinicians regarding the use of telemedicine for this purpose. This chapter identified unique barriers and facilitators to the use of telemedicine that will need to be addressed when designing a telemedicine intervention for conducting family conferences. This thesis describes the importance and process of implementation of telemedicine for the novel purpose of enhancing early communication among physicians and family members of critically ill loved ones. Further studies are needed to refine and investigate patient and family centered clinical outcomes utilizing this intervention

Staff perceptions of best practice for information transfer about multi-trauma patients on discharge from the Emergency Department: a focus group study

Aims & Objectives: To understand: (a) staff perceptions of best practice for information transfer for multi-trauma patients on discharge from the emergency department; (b) what information should be conveyed at transfer and (c) how information is transferred. Background: Information transfer for multi-trauma patients is an integral factor for continuity of care, safety, quality assurance and patient outcomes, however has not been the focus of previous studies. Design: This was a qualitative study using focus group interviews. Methods: Data were collected during focus group interviews across five clinical areas. Themes were derived from the data with consensus from three data coders. Purposive sampling was used and included staff caring for trauma patients during patient transition out of the Emergency Department. Participants were representatives of the Emergency Department, Perioperative Care, Intensive Care Unit, High Dependency Care Unit and the Trauma Service Unit. Twenty-six Registered Nurses and two Medical Officers participated. Results: Five focus group interviews were held. Themes emerged from the data including; ‘Variability’, ‘Continuity’ and ‘Putting the pieces together’. The first three themes were all influenced by the fourth theme of ‘Values/Context’. Considered together these themes influenced staff perception of the quality of information transfer for multi-trauma patients on discharge from the emergency department. Conclusions: Staff perceived best practice for information transfer to be clear, concise, relevant, documentation that travelled with the patient and interactive communication at handover that adhered to agreed principles and a minimum data set specific to trauma patients

The Emerging Culture of Health Care: Improving End-of-Life Care through Collaboration and Conflict Engagement Among Health Care Professionals

Published in cooperation with the American Bar Association Section of Dispute Resolutio

A Conceptual Model of the Role of Communication in Surrogate Decision Making for Hospitalized Adults

OBJECTIVE: To build a conceptual model of the role of communication in decision making, based on literature from medicine, communication studies and medical ethics. METHODS: We proposed a model and described each construct in detail. We review what is known about interpersonal and patient-physician communication, described literature about surrogate-clinician communication, and discussed implications for our developing model. RESULTS: The communication literature proposes two major elements of interpersonal communication: information processing and relationship building. These elements are composed of constructs such as information disclosure and emotional support that are likely to be relevant to decision making. We propose these elements of communication impact decision making, which in turn affects outcomes for both patients and surrogates. Decision making quality may also mediate the relationship between communication and outcomes. CONCLUSION: Although many elements of the model have been studied in relation to patient-clinician communication, there is limited data about surrogate decision making. There is evidence of high surrogate distress associated with decision making that may be alleviated by communication-focused interventions. More research is needed to test the relationships proposed in the model. PRACTICE IMPLICATIONS: Good communication with surrogates may improve both the quality of medical decisions and outcomes for the patient and surrogate