[Handoffs in the intensive care unit]. / Übergaben auf der Intensivstation.

BACKGROUND: Effective handoffs in the intensive care unit (ICU) are key to patient safety. PURPOSE: This article aims to raise awareness of the significance of structured and thorough handoffs and highlights possible challenges as well as means for improvement. MATERIALS AND METHODS: Based on the available literature, the evidence regarding handoffs in ICUs is summarized and suggestions for practical implementation are derived. RESULTS: The quality of handoffs has an impact on patient safety. At the same time, communication in the intensive care setting is particularly challenging due to the complexity of cases, a disruptive work environment, and a multitude of inter- and intraprofessional interactions. Hierarchical team structures, deficiencies in feedback and error-management culture, (technical) language barriers in communication, as well as substantial physical and psychological stress may negatively influence the effectiveness of handoffs. Sets of interventions such as the implementation of checklists, mnemonics, and communication workshops contribute to a more structured and thorough handoff process and have the potential to significantly improve patient safety. CONCLUSION: Effective handoffs are the cornerstone of high-quality and safe patient care but face particular challenges in ICUs. Interventional measures such as structuring handoff concepts and periodic communication trainings can help to improve handoffs and thus increase patient safety.

[Onboarding in intensive care and emergency medicine in Germany]. / Einarbeitung in der Intensiv- und Notfallmedizin in Deutschland.

BACKGROUND: The treatment of acute life-threatening conditions in intensive care and emergency medicine requires in-depth training and education, with initial training playing a key role. RESEARCH QUESTION: What is the structure and quality of the initial training of physicians and nurses in intensive care units and emergency departments in Germany? METHODS: With the help of survey software, an online questionnaire comprising 40 questions in German on the aforementioned topic was designed. It was distributed via the website of the German Society for Internal Intensive Care and Emergency Medicine (DGIIN) and via pertinent social media channels. RESULTS: In total, 103 nurses and 125 physicians participated in the survey. The average work experience of the participating nurses and physicians was 8.5 ± 5.1 and 3.0 ± 3.1 years, respectively. The majority of participants worked primarily in intensive care units (59%) or in emergency departments (22%). On average, the initial training lasted 45 ± 27 and 13 ± 13 days for nurses and physicians, respectively. Only 20% of the initial training comprised seminars or hands-on workshops taught outside of routine clinical care. In all, 47% of the participants stated that they were not able to complete the entire initial training period. Only 49% had been officially certified for usage of the technical equipment in their department. A total of 35% reported feeling confident or somewhat confident in handling predictable tasks after initial training, but only 15% in handling acute emergencies. DISCUSSION: The present study revealed that initial training in intensive care and emergency medicine is frequently incomplete, unstructured, as well as inadequate and bears both safety and liability risks. New concepts are needed to improve the initial training across clinics.

Communication strategies for expressing empathy during family-clinician conversations in the intensive care unit: A mixed methods study.

OBJECTIVES: To explore communication strategies intensive care clinicians and patients' family members prefer for expressing empathy during family-clinician conversations. RESEARCH METHODOLOGY/DESIGN: Mixed-methods survey study. SETTING: Two medical ICUs of a German academic tertiary care hospital. MAIN OUTCOME MEASURES: Using a self-developed online survey with closed and open-ended questions with free-text options, the participants' preferences of communication strategies for expressing empathy were investigated. Quantifiable similarities and differences were determined by statistical analysis. Qualitative themes were derived at by directed content analysis. FINDINGS: The responses of 94 family members, 42 nurses, and 28 physicians were analysed (response rate: 45.3 %). Four communication strategies were deduced: (1) reassuring the families that the intensive care unit team will not abandon neither them nor the patient, (2) acknowledging emotions and offering support, (3) saying that the families are welcome and cared for in the intensive care unit, (4) providing understandable information. In comparison, the families considered an expression of nonabandonment as more empathic than the physicians did (p =.031,r = 0.240), and those expressions focussing solely on the family members' well-being (p =.012,r = 0.228) or comprising evaluative wording ("good", "normal") (p =.017,r = 0.242) as less empathic than the nurses did. Unanimously advocated nonverbal communication strategies included to listen attentively and to avoid interrupting as well as being approachable and honest. CONCLUSION: The participants' preferences supported expert recommendations and highlighted that it is not only important what the clinicians say but also how they say it. Further research is needed to elucidate ways of successfully expressing empathy during family-clinician conversations in the intensive care unit. IMPLICATIONS FOR CLINICAL PRACTICE: Intensive care unit clinicians are encouraged to practice active listening and to express their caring and nonabandonment. It is further suggested to reflect on and adjust pertinent nonverbal behaviours and relational aspects of their communication, as applicable.

Communication strategies for effective family-clinician conversations in the intensive care unit: A mixed methods study.

OBJECTIVES: To explore the perspectives of intensive care patients' family members and clinicians on conveying information during family-clinician conversations. SETTING: Two medical intensive care units of a German academic tertiary care hospital. RESEARCH METHODOLOGY AND DESIGN: This study followed a mixed methods design using a digital survey on family-clinician conversations with open- and closed-ended questions, metric scales, and free-text options. Quantitative analysis was performed to determine similarities and differences. Qualitative directed content analysis was conducted to code all free-text responses into themes. FINDINGS: The responses of 100 family members, 42 nurses, and 28 physicians were analysed (response rate: 47%). All groups preferred face-to-face communication, the ask-tell-ask method, recipient design, and explaining medical terminology. The groups further commented on empathic communication by advocating the acknowledgement of the large amount of information. Qualitative themes highlighting the importance of bedside manners and written information were unique to the family members. Closed-ended questions were identified as potential trouble sources. Two communication strategies were rated as more suitable by the family members than by the physicians: being offered to choose between a summary or a detailed report at the beginning (p =.012;r = 0.288) and receiving a summary and having all questions answered at the end of a conversation (p =.023;r = 0.240). CONCLUSION: The shared preferences supported existing expert recommendations, the differing preferences corroborated the importance of relational aspects of communication and additional written information. More research is needed on empathic communication aspects. IMPLICATIONS FOR CLINICAL PRACTICE: To facilitate understanding, the clinicians may apply recipient design and the ask-tell-ask method, explain medical terminology, summarise important information, and proactively elicit questions. They may use empathic phrasing, demonstrate a respectful demeanour, and reflect on their current use of closed-ended questions and on the relational messages of their communication.

How to communicate with family members of the critically ill in the intensive care unit: A scoping review.

OBJECTIVE: To map the existing approaches to communication with family members of the critically ill in the intensive care unit and the corresponding implementation requirements and benefits. METHODS: We conducted a scoping review in February 2022 by searching PubMed, CINAHL, APA PsycINFO, and Cochrane Library for articles published between 2000 and 2022. We included records of all designs that met our inclusion criteria and applied frequency counts and qualitative coding. RESULTS: The search yielded 3749 records, 63 met inclusion criteria. The included records were of an interventional (43 %) or observational (14 %) study design or review articles (43 %), and provided information in three categories: communication platforms, strategies, and tools. For implementation in the intensive care unit, the approaches required investing time and resources. Their reported benefits were an increased quality of communication and satisfaction among all parties involved, improved psychological outcome among family members, and reduced intensive care unit length of stay and costs. CONCLUSION: The current approaches to communication with patients' family members offer insights for the development and implementation of communication pathways in the intensive care unit of which the benefits seem to outweigh the efforts. Structured interprofessional frameworks with standardised tools based on empathic communication strategies are encouraged.

[Interdisciplinary and interprofessional communication in intensive and emergency care]. / Interdisziplinäre und interprofessionelle Kommunikation im Team.

BACKGROUND: Due to acuteness, time constraints, and psychological pressure as well as changing team compositions, professional communication constitutes a key challenge in the treatment of critically ill patients. OBJECTIVES: The aim of this narrative review is to present the current literature on clinical relevance and current developments of interdisciplinary and interprofessional communication in intensive care and emergency medicine. RESULTS: Effective communication is of great importance in intensive care and emergency medicine, both for ensuring high-quality patient care and work satisfaction as well as mental health of the medical practitioners. Most conflicts occur between the medical and nursing staff, with communicative conflicts predominantly being related to discussions about the patient's prognosis and end-of-life decision-making. Structural measures such as regular team meetings and trainings seem suitable to specifically improve communication. However, the topic is commonly inadequately represented in everyday clinical practice as well as in research. CONCLUSIONS: Even though the importance of interprofessional and interdisciplinary communication for high-quality patient care and workload reduction is increasingly being recognized, its routine application in everyday clinical practice is still scarce, particularly in intensive care and emergency medicine. Due to the specific structure and patient population of these fields of patient care, they can benefit more than other specialties from targeted measures to improve communication.