901 PERCEPTIONS OF HIGH AND LOW QUALITY CARE IN SURGICAL INTENSIVE CARE UNITS AMONG PATIENTS AND THEIR FAMILIES

Introduction: 

Little is known about how stakeholders characterize care quality in critical care units, particularly in surgical intensive care units (SICUs). This qualitative study explores SICU patient and family perceptions of care, specifically what is high and low quailty ICU care as defined by patients and families.

Hypothesis: 

SICU patients and family members relay key insights into high and low quality patient- and family-centered ICU care.

Methods: 

We conducted one-on-one, in-person, in-depth interviews with 13 patients or family members recruited from SICUs in an academic, inner-city, tertiary care hospital. The interviewers used open-ended questions to assess patient and family perceptions of “high” and “low” quality SICU care. Informed by a grounded theory approach and utilizing line-by-line, focused, axial, and theoretical coding, we performed consensus coding on transcribed interviews using co-occurrence matrices to examine the data.

Results: 

In defining “high” quality SICU care, six domains emerged: communication, trust, compassion, involving families in patient care, having a plan, and teamwork. In defining “low” quality SICU care, five domains emerged: poor communication, lack of trust, poor continuity of care providers, lack of teamwork, and unclear provider roles.

Conclusions: 

Domains identified by patients and families as “high” quality SICU care can be largely met by involving patients and families in daily rounds and are consistent with palliative care skills and principles – communication, instilling trust and facilitating teamwork between providers, patients, and families, and supporting and involving both the patient and the family throughout the illness process. Future studies are needed to further explore provider beliefs about quality of SICU care and how they may differ from those identified by patients and families.