Previous studies have shown that when all members of the clinical care team feel comfortable speaking up, team performance improves. With intimate knowledge of patients' wishes, medical histories and clinical conditions, patients and their families are increasingly considered crucial members of the optimal patient-centered care team.

However, to have an impact on patient safety, patients and families must feel comfortable voicing concerns about care to the medical team. Currently, little is known about patients' and their families' level of comfort with speaking up in real time in the ICU setting. The study was published in BMJ Quality and Safety.

ICU Experiences

In a new study, a team led by clinician-researchers at Beth Israel Deaconess Medical Center (BIDMC) surveyed family members and patients with recent ICU experiences about their willingness to speak up about care concerns to medical providers. They revealed that 50 to 70% of family member respondents with a loved one in the ICU at the time of the survey expressed hesitancy about voicing their concerns about common care situations with safety implications.

Patient Safety

Speaking up is a key component of safety culture, yet our study the first to our knowledge to address this issue revealed substantial challenges for patients and families speaking up during an ICU stay.

In the ICU setting, in particular, families who are also among the most vigilant stakeholders may hold key information clinicians may have overlooked, and maybe the first to detect a change in clinical status. Our findings are important because true partnerships with patients and families may be limited if they don't feel supported to voice their concerns.

Using a questionnaire collaboratively designed by a multidisciplinary group including experts from the Patient and Family Advisory Council at BIDMC, BIDMC's Center for Healthcare Delivery Science, Department of Social Work and Department of Health Quality Care, and collaborators at Intermountain Medical Center at the University of Utah, Bell and colleagues surveyed 105 families of patients admitted to an urban academic hospital's ICUs from July 2014 to February 2015.

The team also surveyed a panel of 1050 participants with recent ICU experience via the internet. The data revealed that while nearly two-thirds of current ICU patients and families reported feeling very comfortable discussing medications, only about one-third of respondents said they felt the same way about discussing hand hygiene or disagreements about the aggressiveness of care desired by patients/families versus that proposed by clinicians.

Patient's Comfort

Only half of those surveyed reported feeling very comfortable asking for clarification about confusing or conflicting information or raising concerns about a possible error. Fear of being labeled a "troublemaker," not knowing whom to talk to, and the medical team's busyness were the most often cited reason for that hesitancy.