Methods
The toolkit we present here is informed by a large program of research,
some of which has been reported elsewhere 9,10, and
some which we report here for the first time.
Ethnographic study: Our research program began with an
observational study of family participation in ICU care team rounds10. We conducted ethnographic observations of rounds,
employing both structured (documentation of pre-specified processes) and
unstructured (note-taking to characterize interactions and context) data
collection techniques to directly observe and describe family member
attendance in ICU rounds in seven medical-surgical ICUs located in seven
hospitals in three Canadian cites in the province of Alberta.
Interviews and focus groups: Interviews and focus groups with
family and healthcare providers were conducted in four urban tertiary
care medical-surgical ICUs within a large city, and in five additional
ICUs across Alberta, one of which was an urban tertiary care centre and
the others which serve a rural patient population 9.
These in-depth interviews and focus groups explored facilitators,
barriers, and suggestions for improvement from the perspectives of
participants in ICU family rounds. Our research program culminated in a
full-day toolkit development workshop.
Workshop: A diverse group of family members and healthcare
providers from 14 adult ICUs were invited to attend a one-day, 8-hour
workshop to deliberate upon and collaboratively develop a toolkit to
guide patient and family centered rounds. The key facilitators
identified through our qualitative observations and interviews9,10 were incorporated into an electronic survey with
a 5-point Likert scale for rating the importance of each facilitator,
along with 2 open-ended questions for respondents to write additional
facilitators and site-specific contextual factors (see Appendix 1). The
survey was distributed to family members and providers one week before
the workshop to identify the highest priority elements of patient- and
family-centered rounds. Family members and providers were provided with
a summary of key findings from the research to date, and were asked to
come to the workshop prepared to discuss ideas on how key processes
involved in patient-and family-centered rounds could be developed into a
practical toolkit for use in the clinical setting.
The workshop was held on November 5th, 2018 and
divided into morning and afternoon sessions. The day commenced with a
review of existing literature, findings from previous research, and
objectives for the workshop, which were to 1) consolidate components of
the toolkit including structures, processes, and existing tools, 2)
refine toolkit components to optimize communication with all
stakeholders, and 3) prioritize further tool development. Participants
were divided into six groups. Groups rotated through 12 stations
representing structures, processes and tools to guide implementation of
the 6 highest priority elements of patient- and family-centered rounds
identified in the pre-workshop survey. Groups were asked to generate
ideas on the structures, processes and tools, and vote on the importance
and relevance of the tools. At the end of the morning and afternoon
sessions, large group discussions were held to review and discuss the
ideas generated at each workshop station and establish consensus on
which elements to include in the final toolkit.
The collaborative worksheets from each activity station were retained
for subsequent analysis and to support toolkit development. Three
research team members independently took memos during the group
discussion portions of the workshop, which were also audio-recorded and
transcribed verbatim. The three sets of notes were compiled and collated
to create a record of the discussions; the researchers reviewed the
collated notes and transcripts for fidelity. From the notes and
transcripts, the researchers assembled a consensus list of toolkit items
that had been agreed upon and discussed by workshop participants,
including numerous suggestions and examples of their application. This
consensus list formed the basis for the final toolkit components
reported below.