Surgical Icu Views

General Goods

Intensive care unit (ICU) patients and family members repeatedly note accurate and timely communication from health care providers to be crucial to high-quality ICU care. Practice guidelines recommend improving communication. However, few data, particularly in surgical ICUs, exist on health care provider opinions regarding whether communication is effective.

ICU nurses, surgeons, and ICU intensivists and NPs varied widely in their satisfaction with communication relating to prognosis. Clinician groups also varied in whether they thought that they had opportunities to communicate prognosis and whether their concerns were valued by other provider groups. These results hint at the nuanced and complicated relationships present in surgical ICUs. Further validation studies and further evaluations of patient and family member perspectives are needed.

As in other settings, optimal communication in the ICU includes discussion of the disease, prognosis, goals of care, treatment options, and patient preferences. Proactive ICU communication should also address preferences regarding resuscitation. When burdens of intensive care treatment outweigh benefit, discussion of limitation of this treatment is also appropriate. Evidence suggests that clinicians working in surgical ICUs find this type of communication to be particularly challenging. Surgical textbooks contain scant content related to communication of distressing news or goal setting [16]. The rescue culture that dominates many surgical ICUs may also further impede such discussions [17-20]. Moreover, as these discussions can reveal varying goals of care between health care providers, they often cause moral distress and conflict [21,22].

Data from our own institution suggest that patients receiving surgical ICU care for more than 7 days have a high (41%) rate of in-hospital mortality [23]. Thus, the specific aim of this article is to investigate the views and experiences of clinicians working in the surgical ICU regarding the adequacy and efficacy of communication regarding prognosis for surgical ICU patients.