Designing Provider-Patient Family Conversation Spaces in the Neuro-ICU

Provider-Patient Family (PPF) conversations in the form of goals-of-care, transition-of-care or end-of-life meetings require families or surrogates of patients to make critical decisions on behalf of their loved ones, impacting a number of outcomes, including costs of care, type of intervention and the patient’s length of stay. These conversations involve various challenges for care providers, including coordinating the meetings, disseminating necessary information to family surrogates and care team members, and anticipating diverse family needs. The study uses the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 framework to identify how multiple systemic factors influence the effectiveness of the meetings, with a specific emphasis on coordination and decision-making. To this end, thirty meetings between providers and patient families will be observed in the Neurological ICU of a large hospital system in South Carolina. Following the meetings, family members will be asked to fill out a survey to gauge their satisfaction with the conversation. The provider team will also be asked to fill out two surveys to assess their perceived quality of communication, and their physical and cognitive workload. In addition, semi-structured interviews will be conducted with care providers and family members to delve deeper into the challenges and facilitators of effective coordination and decision-making. Data will be analyzed qualitatively and quantitatively to develop insights that will inform a multi-user-centered design framework to better support planning and coordination of PPF conversations in the ICU.