Satisfaction with Care and Satisfaction with Decision Making are Similar Regardless of Staffing Model in a Neurocritical Care Unit

Abstract

Introduction: Patient-centered care, particularly shared medical decision making, is difficult to measure in critically ill patients where decisions are often made by a designated surrogate, often receiving information from multiple providers with varying degrees of training. The purpose of this study was to compare short-term satisfaction with care and decision making in patients or surrogates between two neurocritical care units [one staffed by a neurocritical care attending and advanced practice providers (APPs) and one staffed by a neurocritical care attending and resident/fellow trainees] using the Family Satisfaction in the ICU (FS-ICU) survey.Methods: Over a 6-month period, the FS-ICU was administered on a tablet device to patients or surrogates at least 24 h after admission and stored on REDCap database.Results: One hundred and thirty-four patients or surrogates completed the FS-ICU. The response rates were 59.97% and 46.58% in the APP and trainee units, respectively. There were no differences in patient age, sex, ventilator days or ICU length of stay. Overall, there were no differences in satisfaction with care or perceived shared medical making between the units. Respondents who identified their relationship with the patient as "other" (not a spouse, parent, nor a sibling) were less satisfied with care. Additionally, surrogates who identified as parents of the patient were more satisfied with degree of shared medical decision making. Conclusion:This study showed that: (1) collecting FS-ICU in a neurocritical care unit is feasible, (2) overall there is no difference in short-term satisfaction with care or shared decision making between a NICU staffed with trainees compared to one staffed with APPs, and (3) parents of patients have a higher short-term satisfaction with degree of shared medical decision making.

Workload in the Cardiac ICU: You Down With APPs?*

“…Previous examination of APPs in critical care environments has found APP teams to be associated with reduced length of stay, lower complication rates, increased compliance with clinical based guidelines, increased revenue, reduced costs, and increased patient/family satisfaction (7)(8)(9)(10)(11)(12). To help alleviate the operational strain and disperse workload burden, there have been a rising number of APPs recruited to the FLP role in cardiac ICUs around the nation (4).…”

“…The long-term care of chronic patients and their families allows APPs to enhance the patient and family experience as stable and familiar sources of support. Patients and their family members in a neurocritical care unit reported overall positive feedback regarding the care and support they received from an APP team (10).…”