Communication with patients during ward rounds on the intensive care unit: a prospective, observational, semiblind study

Introduction

It is good medical practice to communicate with patients regarding their condition and proposed treatment. Communication is essential to allow them to express their concerns and exercise their own autonomy, in a situation where they otherwise may have little control. Poor communication may contribute to unnecessary anxiety or depression. The aim of this audit was to observe whether the doctors communicated with patients on ward rounds.

Methods

We audited 28 ICU ward rounds. It was noted whether the patient was sedated or not sedated, and whether they had their eyes open or closed. Negative comments were recorded, and defined as comments regarding a patient's poor progress or prognosis made at the bedside during the ward round. We also noted whether the patient was informed that the ward round was in progress, whether they were informed of the plan for the day, and whether any reassurance was offered. The other members of the team were not aware of the audit.

Results

Twenty-eight ward rounds were audited, a total of 328 patient reviews. The total number of patients with their eyes open was 171, while 157 had their eyes closed. An adverse comment was made during 8.2% of reviews within earshot of the patient. A negative comment was made on 27 episodes, 13 of these were when the patient was not sedated but had their eyes closed. Four episodes occurred when the patient was not sedated and had their eyes open, while 10 were sedated and had their eyes closed. Of the 171 patients with their eyes open, 74 (43%) were informed that we were the team doing the ward round, while 97 (57%) were not spoken to at the start of the review. Fifty-three (31%) were informed of our management plan for the day and 43 (25%) were offered reassurance. In total, 103/171 patients (60%) with their eyes open were spoken to during the ward round, and we did not speak to 68 (40%).

Conclusion

On intensive care ward rounds, patients are often not engaged in conversations or allowed to express their concerns. The majority of patients were not offered reassurance or informed about the treatment plan. Improved communication skills may help to lessen patients' anxiety and unnecessary stress both during their stay on ICU and following their discharge.