Patient and family satisfaction with care in step-down units

Introduction

The purpose of this study was to determine the level of satisfaction of patients and families with the care received in step-down units (SDUs). In an effort to alleviate ICU demand, many centers have opted to provide graded levels of critical care in SDUs. However, there is a paucity of literature as to the effectiveness of care delivered in SDUs. Measures of patient and family satisfaction with healthcare are recognized as valuable tools for the assessment of healthcare delivery including adherence to patient-centered and family-centered quality care. Literature examining patient or family satisfaction in SDUs is limited.

Methods

We administered a modified version of the previously validated Family Satisfaction with ICU care survey to patients and families of patients who were cared for in the SDUs (18 beds in four separate units) of a tertiary regional referral center. We obtained self-reported levels of patient and family satisfaction with 27 aspects of care related to SDU experience, communication, and decision-making. Responses were converted to item scores, which reflect poor to excellent satisfaction with care (0–100).

Results

A total of 120 patient surveys (60% response) and 99 family surveys (45% response) were completed. Patients had a mean SDU length of stay of 2.5 days, APACHE II score of 9.9 and an SDU mortality of 2.4%. The highest levels of satisfaction with care were (mean ± standard deviation item score; presented as aspect of care, patients, families, P value): overall care (aggregate score), 81.1 ± 21.5, 80.1 ± 22.3, NS; concern and caring received from SDU staff, 87.9 ± 17.1, 90.4 ± 5.0, NS; and nurses' skill and competence, 88.7 ± 16.0, 88.8 ± 16.6, NS. The lowest levels of satisfaction were: frequency of communication with physicians, 71.6 ± 27.8, 62.7 ± 32.2, P = 0.03 and decision-making (aggregate score), 67.5 ± 29.9, 62.7 ± 30.5, NS. For the decision-making process, a proportion of respondents felt they were not included (patients, families, P value; 40.3%, 42.7%, NS), not supported (31%, 38.6%, NS), and not in control (32.7%, 55.3%, P = 0.001). Patients and families were least satisfied with the frequency of communication with physicians and participation in decision-making. Patients and families were similar in their assessments with the exception of the frequency of communication with physicians and control of the care delivered.

Conclusion

While most patients and family members were satisfied with care received, these data identify opportunities for improvement. Specifically, attention must be paid to communication and decision-making processes in SDUs.