Defining Communication Vulnerability and Patient Safety During Critical Illness

Patients in the Intensive Care Unit (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 and health equity priority. 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.