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  • Measure Summary
  • NQMC:005618
  • Aug 2006

Family members' satisfaction with care in the intensive care unit: mean overall score on the Family Satisfaction in the Intensive Care Unit© (FS-ICU 24) questionnaire.

Heyland DK. Family Satisfaction with Care in the Intensive Care Unit© (FS-ICU 24) version 11. Canada: Canadian Researchers at the End of Life Network (CARENET); 2006 Aug 15. 7 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2016.

Primary Measure Domain

Clinical Quality Measures: Patient Experience

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the overall satisfaction of family members of patients in the intensive care unit based upon their responses to the Family Satisfaction in the Intensive Care Unit© (FS-ICU 24) questionnaire.

Rationale

In the intensive care unit (ICU), patient-centered care includes family-centered care. Since most ICU patients cannot make decisions for themselves, families are often involved as surrogate decision makers. Therefore, the perspectives of family and other surrogate decision makers are especially important in the critical care setting, and family satisfaction is an important outcome measure.

Families have an important role in sharing relevant information, for example: what transpired before the admission; what kind of person the patient is; and, perhaps most importantly, what the patient would want in terms of care, given the current situation.

A key domain of quality of care is satisfaction with care. Because desirable health status outcomes may not be attained after critical illness and because mortality rates in tertiary referral ICUs may approach 15% to 20%, satisfaction with care is important not only to patients but also to their families. Furthermore, given that the majority of critically ill patients (especially those at high risk for poor outcomes) are unable to participate in decision making about treatments, the family's perspective is central to understanding (and measuring) satisfaction with care in the ICU.

Evidence for Rationale

Cohen LM, McCue JD, Green GM. Do clinical and formal assessments of the capacity of patients in the intensive care unit to make decisions agree. Arch Intern Med. 1993 Nov 8;153(21):2481-5. PubMed External Web Site Policy

Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004 Apr 14;291(14):1753-62. PubMed External Web Site Policy

Hall RI, Rocker GM. End-of-life care in the ICU: treatments provided when life support was or was not withdrawn. Chest. 2000 Nov;118(5):1424-30. PubMed External Web Site Policy

Heyland DK, Rocker GM, Dodek PM, Kutsogiannis DJ, Konopad E, Cook DJ, Peters S, Tranmer JE, O'Callaghan CJ. Family satisfaction with care in the intensive care unit: results of a multiple center study. Crit Care Med. 2002 Jul;30(7):1413-8. PubMed External Web Site Policy

Kryworuchko J, Heyland DK. Using family satisfaction data to improve the processes of care in ICU. Intensive Care Med. 2009 Dec;35(12):2015-7. PubMed External Web Site Policy

Stewart AL, Teno J, Patrick DL, Lynn J. The concept of quality of life of dying persons in the context of health care. J Pain Symptom Manage. 1999 Feb;17(2):93-108. [75 references] PubMed External Web Site Policy

Wall RJ, Engelberg RA, Downey L, Heyland DK, Curtis JR. Refinement, scoring, and validation of the Family Satisfaction in the Intensive Care Unit (FS-ICU) survey. Crit Care Med. 2007 Jan;35(1):271-9. PubMed External Web Site Policy

Primary Health Components

Family satisfaction; intensive care unit; decision-making

Denominator Description

Family members of intensive care unit patients who completed the Family Satisfaction in the Intensive Care Unit© (FS-ICU 24) questionnaire (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Respondents' answers to the Family Satisfaction in the Intensive Care Unit© (FS-ICU 24) questionnaire (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

  • Family satisfaction reflects the amount of fulfillment of needs and expectations. Of note, healthcare professionals are not always aware of all the needs that might be of relevance and only few studies have hitherto addressed expectations of patients and their families. One example is an analysis of the expected written information that relatives of adult patients in the intensive care unit (ICU) would like to receive. Interestingly, relatives wanted more information than was anticipated by ICU physicians, suggested in guidelines, or found in information booklets. Also, there may be differences in the needs of family members and those assumed by critical care nurses.
  • Qualitative interviews and audits of our communication with families can help us to better understand the association between survivorship and satisfaction, how expectations mediate satisfaction, and when and how families want to be engaged in decision making. We know that some families are not even aware that decisions are being made at the end of life and therefore are neither engaged nor involved [9–12]. It would be helpful to better understand how families and their healthcare teams deliberate amongst the options in order to reach consensus about decisions, or whether such consensus is necessary or even desirable.

Evidence for Additional Information Supporting Need for the Measure

Kryworuchko J, Heyland DK. Using family satisfaction data to improve the processes of care in ICU. Intensive Care Med. 2009 Dec;35(12):2015-7. PubMed External Web Site Policy

Maxwell KE, Stuenkel D, Saylor C. Needs of family members of critically ill patients: a comparison of nurse and family perceptions. Heart Lung. 2007 Sep-Oct;36(5):367-76. PubMed External Web Site Policy

Rodriguez RM, Navarrete E, Schwaber J, McKleroy W, Clouse A, Kerrigan SF, Fortman J. A prospective study of primary surrogate decision makers' knowledge of intensive care. Crit Care Med. 2008 May;36(5):1633-6. PubMed External Web Site Policy

Rothen HU, Stricker KH, Heyland DK. Family satisfaction with critical care: measurements and messages. Curr Opin Crit Care. 2010 Aug 21;:Epub ahead of print. PubMed External Web Site Policy

Soltner C, Lassalle V, Galienne-Bouygues S, Pottecher J, Floccard B, Delapierre L, Jungfer F, Sargentini C, Alberti C, Beydon L, Lifrea Group. Written information that relatives of adult intensive care unit patients would like to receive--a comparison to published recommendations and opinion of staff members. Crit Care Med. 2009 Jul;37(7):2197-202. PubMed External Web Site Policy

Sprung CL, Woodcock T, Sjokvist P, Ricou B, Bulow HH, Lippert A, Maia P, Cohen S, Baras M, Hovilehto S, Ledoux D, Phelan D, Wennberg E, Schobersberger W. Reasons, considerations, difficulties and documentation of end-of-life decisions in European intensive care units: the ETHICUS Study. Intensive Care Med. 2008 Feb;34(2):271-7. PubMed External Web Site Policy

White DB, Curtis JR, Wolf LE, Prendergast TJ, Taichman DB, Kuniyoshi G, Acerra F, Lo B, Luce JM. Life support for patients without a surrogate decision maker: who decides. Ann Intern Med. 2007 Jul 3;147(1):34-40. PubMed External Web Site Policy

Workman S, Mann OE. 'No control whatsoever': end-of-life care on a medical teaching unit from the perspective of family members. QJM. 2007 Jul;100(7):433-40. PubMed External Web Site Policy

Extent of Measure Testing

The Family Satisfaction in the Intensive Care Unit© (FS-ICU 24) questionnaire is a valid and reliable tool for assessing family satisfaction in the intensive care unit (ICU). Scores on the FS-ICU show good validity against other indicators of ICU quality.

Evidence for Extent of Measure Testing

Wall RJ, Engelberg RA, Downey L, Heyland DK, Curtis JR. Refinement, scoring, and validation of the Family Satisfaction in the Intensive Care Unit (FS-ICU) survey. Crit Care Med. 2007 Jan;35(1):271-9. PubMed External Web Site Policy

State of Use

Current routine use

Current Use

Internal quality improvement

Quality of care research

Measurement Setting

Hospital Inpatient

Intensive Care Units

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physicians

Social Workers

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Adults (no pediatrics)

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Person- and Family-centered Care

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Patient-centeredness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Institutionalization

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Family members of intensive care unit patients who made at least one visit and completed* the Family Satisfaction in the Intensive Care Unit© (FS-ICU 24) questionnaire

*"Completed" surveys are defined as those with at least 70% of the items in the respective scale completed.

Exclusions
Unspecified

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
Respondents' answers to the Family Satisfaction in the Intensive Care Unit© (FS-ICU 24) questionnaire. From the responses, a scale score is calculated. On this scale, 0 is "least satisfied" and 100 is "most satisfied."

Refer to the Family Satisfaction in the Intensive Care Unit© (FS-ICU): Instructions for Recoding and Scoring document listed in the "Companion Documents" field for additional information on scoring.

Exclusions
Questionnaires with less than 70% of the items in the "Satisfaction with Care" scale and the "Family Satisfaction with Decision-making Around Care of Critically Ill Patients" are excluded from scoring analysis.

Numerator Search Strategy

Fixed time period or point in time

Data Source

Patient/Individual survey

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Family Satisfaction with Care in the Intensive Care Unit© FS-ICU (24)

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Composite/Scale

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Family Satisfaction in the Intensive Care Unit© (FS-ICU 24) - overall score.

Measure Collection Name

Family Satisfaction in the Intensive Care Unit© (FS-ICU 24) Questionnaire

Submitter

Heyland, Daren K., MD, MSc - Independent Author(s)

Developer

Heyland, Daren K., MD, MSc - Independent Author(s)

Funding Source(s)

Unfunded

Composition of the Group that Developed the Measure

Multidisciplinary Research Group at Kingston General Hospital

Financial Disclosures/Other Potential Conflicts of Interest

None

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2006 Aug

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2016.

Source(s)

Heyland DK. Family Satisfaction with Care in the Intensive Care Unit© (FS-ICU 24) version 11. Canada: Canadian Researchers at the End of Life Network (CARENET); 2006 Aug 15. 7 p.

Measure Availability

Source available from the CARENET Web site External Web Site Policy.

For more information, contact Dr. Daren Heyland at Kingston General Hospital, 76 Stuart St., Angada 3, Kingston, ON, K7L-2V7; E-mail: dkh2@queensu.ca; Web site: www.thecarenet.ca/resource-center/family-satisfaction-survey External Web Site Policy.

Companion Documents

The following are available:

  • Heyland DK. Family satisfaction in the intensive care unit© (FS-ICU): instructions for recoding and scoring. Canada: Canadian Researchers at the End of Life Network (CARENET); 2006 Jul. 3 p. This document is available from the CARENET Web site External Web Site Policy.
  • Heyland DK. Overview of FS-ICU item reduction. Canada: Canadian Researchers at the End of Life Network (CARENET); 3 p. This document is available from the CARENET Web site External Web Site Policy.
  • Heyland DK. Family satisfaction with care in the intensive care unit© (FS-ICU 34) version 11. Canada: Canadian Researchers at the End of Life Network (CARENET); 2006 Aug 15. 9 p. This document is available from the CARENET Web site External Web Site Policy.

For more information, contact Dr. Daren Heyland at Kingston General Hospital, 76 Stuart St., Angada 3, Kingston, ON, K7L-2V7; E-mail: dkh2@queensu.ca; Web site: www.thecarenet.ca/resource-center/family-satisfaction-survey External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on July 20, 2010. The information was verified by the measure developer on August 16, 2010.

This NQMC summary was retrofitted into the new template on June 6, 2011.

The information was reaffirmed by the measure developer on January 28, 2016.

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