# Connecting in Crisis: Enhancing Family Satisfaction in the Intensive Care Unit Through Effective Communication in an Indian Tertiary Care Hospital

## TL;DR

This study evaluates family satisfaction in an ICU at an Indian hospital and finds that communication improvements boost satisfaction, especially in decision-making.

## Contribution

The study introduces quality improvement initiatives in an Indian ICU setting, showing measurable improvements in family satisfaction through communication training and multidisciplinary meetings.

## Key findings

- Family satisfaction was high overall, with higher satisfaction in care than in decision-making domains.
- Quality improvement initiatives significantly improved both care and decision-making satisfaction scores.
- Families of non-ventilated patients reported better communication and consideration from ICU staff.

## Abstract

Background

Patient satisfaction is an important indicator of the quality of healthcare. However, in critically ill patients who are unable to actively participate in the decision-making process or provide feedback, the satisfaction of their family members is important. The modified Family Satisfaction in the Intensive Care Unit (FS-ICU-24R) questionnaire is a globally validated tool to measure the quality of care in the intensive care unit (ICU) from the perspective of the patient’s family. Therefore, this study aimed to evaluate the performance of our tertiary care center using this questionnaire and identify factors influencing family satisfaction in the ICU and areas requiring improvement to improve healthcare quality.

Methodology

This retrospective cohort study was conducted in the ICU of an Indian tertiary care hospital. Data were collected from the FS-ICU-24R surveys administered to adult family members of critically ill patients admitted to the ICU for at least seven days between January 1, 2019, and October 31, 2024. Family satisfaction was further subdivided into satisfaction with care (FS-Care) and decision-making (FS-DM) domains based on the FS-ICU-24R questionnaire. To enhance family satisfaction, our hospital implemented two quality improvement initiatives in 2022: (1) communication skills workshops for ICU staff and (2) multidisciplinary meetings with the families of long-stay ICU patients. Descriptive statistics were used to characterize participant and patient characteristics and family satisfaction scores. Differences between satisfaction levels were analyzed using a two-sample t-test. Spearman’s rho was used to assess the correlation of patient and participant characteristics with family satisfaction.

Results

This study included 614 participants with a 98.5% (605/614) response rate. We found a high overall family satisfaction level (86.83 ± 19.52), with higher satisfaction with FS-Care (87.7 ± 19.0) than FS-DM (85.4 ± 20.4). A similar trend was observed when the patient cohort was grouped based on the need for mechanical ventilation. While we found no significant difference in the family satisfaction levels based on ventilation status, families of non-ventilated patients were more satisfied with the consideration provided by the ICU staff and the communication frequency with nursing staff than the families of ventilated patients. Family satisfaction levels did not correlate with any participant or patient characteristic. Considering our tertiary care status, a majority (~31%, 154/502) of the patient cohort had high APACHE II scores reflecting their critical condition, with 78% (455/582) requiring mechanical ventilation. Implementation of quality improvement measures resulted in significant improvements in both FS-Care (84.8 ± 18.6 vs. 88.3 ± 19.0) and FS-DM (79.7 ± 22.4 vs. 86.5 ± 19.8) domains.

Conclusions

While the family satisfaction of patients admitted to the ICU in our hospital was relatively high, there remain areas for improvement. The satisfaction level with the FS-DM domain was lower compared to that for the FS-Care domain; however, this trend has been observed in healthcare institutions globally. Moreover, as our hospital is a tertiary institute, the patient population comprises more critical cases that require immediate treatment, reducing the time that can be afforded to make decisions. Nevertheless, the implementation of quality improvement measures enhanced the family satisfaction levels.