A new study examine many family members of intensive care unit (ICU) patients are reluctant to tell medical staff of worries about their loved one's care. 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.

They surveyed 105 families of patients admitted to an academic hospital's ICU between July 2014 and February 2015. The researchers also conducted an internet survey of 1,050 people with recent ICU experience. The study was published in the journal BMJ Quality and Safety.

ICU Care

Nearly two-thirds of ICU patients and families said they felt very comfortable talking to medical staff about medications, but only one-third said they felt comfortable bringing up concerns about hand hygiene or aggressiveness of care.

Only half the respondents said they were very comfortable asking for clarification about confusing or conflicting information or raising concerns about a possible error. The main reasons for their reluctance were fear of being labeled a "troublemaker," not knowing which person to talk to, and the medical team being very busy.

Younger people, men and those without personal experience in health care were less likely speak up, according to the researchers. The study authors noted that the people included in the study were English-only speakers and many were college-educated and had connections to the health care industry, so the findings likely underestimate the problem.

Patient's Care

In the ICU setting in particular, families, who are also among the most vigilant stakeholders  may hold key information clinicians may have overlooked, and may be 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. Our results highlight the need to explicitly support patients and families to speak up in real time about perceived errors. Hesitancy to do so represents a real safety gap.