Satisfaction with quality of ICU care for patients and families: the euroQ2 project

Abstract

BackgroundFamilies’ perspectives are of great importance in evaluating quality of care in the intensive care unit (ICU). This Danish-Dutch study tested a European adaptation of the “Family Satisfaction in the ICU” (euroFS-ICU). The aim of the study was to examine assessments of satisfaction with care in a large cohort of Danish and Dutch family members and to examine the measurement characteristics of the euroFS-ICU.MethodsData were from 11 Danish and 10 Dutch ICUs and included family members of patients admitted to the ICU for 48 hours or more. Surveys were mailed 3 weeks after patient discharge from the ICU. Selected patient characteristics were retrieved from hospital records.ResultsA total of 1077 family members of 920 ICU patients participated. The response rate among family members who were approached was 72%. “Excellent” or “Very good” ratings on all items ranged from 58% to 96%. Items with the highest ratings were concern toward patients, ICU atmosphere, opportunities to be present at the bedside, and ease of getting information. Items with room for improvement were management of patient agitation, emotional support of the family, consistency of information, and inclusion in and support during decision-making processes. Exploratory factor analysis suggested four underlying factors, but confirmatory factor analysis failed to yield a multi-factor model with between-country measurement invariance. A hypothesis that this failure was due to misspecification of causal indicators as reflective indicators was supported by analysis of a factor representing satisfaction with communication, measured with a combination of causal and reflective indicators.ConclusionsMost family members were moderately or very satisfied with patient care, family care, information and decision-making, but areas with room for improvement were also identified. Psychometric assessments suggest that composite scores constructed from these items as representations of either overall satisfaction or satisfaction with specific sub-domains do not meet rigorous measurement standards. The euroFS-ICU and other similar instruments may benefit from adding reflective indicators.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1826-7) contains supplementary material, which is available to authorized users.

Validation and Analysis of the European Quality Questionnaire in Italian Language

“…The results of the statistical analysis indicate adequate coherence and internal cohesion of the instrument comparing to the Danish-Dutch original articles [25,26].…”

“…The euroQ2 was translated into Italian and proposed to the relatives of the patients in ICU with the Hospital Anxiety and Depression Scale (HADS) [23] and Impact of Event Scale-Revised (IES-r) [24]. As in the original study [25,26] HADS and IES-r, were used to assess the possible association between the responses to euroQ2 and the emotional state of the relatives themselves. The euroQ2 was administered close to the time when the patient was transferred to the wards.…”

“…Like its predecessors, euroQ2 is a versatile tool, useful for the evaluation of quality indicators in the clinical governance process [20][21][22][23][24]. The versatility and reliability of the original instruments has therefore been adapted to the European context in a simpler and clearer single format [25,26]. Moreover, it has been successfully used both to highlight possible areas of improvement within the unit and to evaluate the effectiveness of training activities [20][21][22][23][24].…”

Comparison of complaints to the intensive care units and those to the general wards: an analysis using the Healthcare Complaint Analysis Tool in an academic medical center in Taiwan

“…The report by Heyland et al shows that the family is least satisfied with the waiting room atmosphere and frequency of physician communication [ 25 ]. Other themes for improvement reported in the literature included ICU atmosphere, amenities for visiting relatives, emotional support, consistency, clarity, and completeness of information, respect and compassion towards families, the inclusion of family, and support during decision-making processes [ 3 , 4 , 6 , 25 ]. Despite the fact that family and relatives of the patients in ICU are expected to have both a receiving and participating role [ 26 ], families might also encounter unsupportive interactions, which might result from poor communication [ 27 ].…”

Information concerning ICU patients’ families in the handover—The clinicians’ «game of whispers»: A qualitative study

“…Family members need access to ICU to ensure their proximity to the patient and to receive thorough and honest information about the patient's condition (Briggs, 2017;Frivold, Slettebo, & Dale, 2016). Inadequate communication and inconsistent information from ICU nurses and physicians are often the main cause of dissatisfaction in families of ICU patients (Frivold et al, 2016;Jensen et al, 2017). This suggests that the ICU team need to improve their communication and cooperation regarding these families.…”