Communication Vulnerability and Patient Safety Reporting during Critical Illness

Protecting patient safety is an integral component of healthcare. Reporting mechanisms to support patient safety exist, however, they are primarily initiated by staff, and occasionally by clinicians. Reporting mechanisms for patients and family members have been underused or are non-existent. This may be particularly important for patients in critical care (i.e., Intensive Care Unit (ICU)) since patients using mechanical ventilation have severe communication impairments. 

Patients in the ICU commonly experience communication difficulty due to illness and equipment that prevent them from expressing themselves verbally and non-verbally. Patients consistently report that communication difficulty experienced in critical care is one of the most “frustrating” and “dehumanizing” parts of their hospitalization. Communication difficulty impacts patients’ ability to report symptoms and needs, and yet has not been framed as an essential patient safety priority. Indeed, patients with communication difficulty have three times higher rate of safety incidents in hospitals.

This project aims to better understand communication difficulty, or vulnerability, through a critical disability framework. This project also aims to better understand how patients and families in critical care relay breakdowns in care quality, safety, and experiences including perceived safety incidents. We will ask surviving patients and their family to recall perceived safety incidents and breakdowns in care related to communication vulnerability. We will also ask critical care staff about mechanisms for reporting on behalf of patients. Finally, we will review reported safety incidents and reports to patient relations from critical care environments to better characterize types of incidents reported using standard mechanisms (e.g., safety incident reports and patient relation calls) that are related to communication.

This is an important study to explore the impact of communication vulnerability in critical care on patient safety. We will use the findings from this study to design patient inspired interventions to protect patient and family safety in critical care environments. This study uses a qualitative descriptive methodology, employing mixed-methods to integrate reported safety incidents with reported perceptions of patient safety in critical care.