Results
Out of 55 individuals invited a total of 23 participants attended the toolkit development workshop, including ICU physicians (n=4), nurses (n=5), unit managers (n=8), family member representatives and advisors (n=6), one social worker, and one spiritual care practitioner. Three participants were from rural sites, while the majority of attendees (n=20) were from large urban community or academic hospitals.
Seventeen participants completed the pre-workshop survey, fourteen of whom self-identified as healthcare providers and three who self-identified family members (see Appendix 1). Based on our ethnographic data, interviews and focus groups, and the pre-workshop survey, we identified six elements foundational to patient and family centered rounds: Invitation, Orientation, Engagement, Summary, Questions, and Communication Follow-Up (Figure 1). For each element, the structures and processes that promote communication, relationship-building, and shared decision-making identified in the workshop and the associated tools to support these practices are described below. Tools include standardized unit practices, key talking points, education aids, mnemonics, written templates and local champions, and are summarized in the Supplemental Material as a complete guide. Select tools and quotations are illustrated in Table 1.

Invitation

  1. Healthcare providers inviting family members to roundsWorkshop participants recommended educating staff that inviting families to rounds is the standard of care and part of unit culture. Any member of the care team can encourage family attendance, and multiple invitations are beneficial.
  2. When and where to invite family members to roundsParticipants suggested inviting family as soon as is practical (e.g., at first contact with family, and if possible in the presence of a patient who is awake and aware), with reminders throughout the patient’s ICU stay.
  3. Who to invite to roundsParticipants indicated it is ideal to ask the patient who they would like to participate in rounds. For patients who are unconscious or unable to make decisions, participants suggested asking the surrogate decision maker to select an attendee. Participants considered an appropriate rounds attendee to be someone the patient would likely agree to have present, who could reflect the patient’s voice, and who feels reasonably comfortable participating. For large extended families, participants suggested that a single family spokesperson could attend rounds and relay information to the larger family unit.
  4. Supporting materials for families invited to roundsTo promote consistent messaging, participants suggested providing staff with standard information on how to invite family members to rounds. Recommended tools included pamphlets, invitation cards, and posters to accompany verbal invitations and aid family members’ understanding and recall. Participants indicated written materials would ideally be simple, concise, identify the structure and purpose of rounds, and include illustrative pictures and graphics. Posters in waiting areas were suggested as a passive means to raise awareness of rounds, as well as index-sized invitation cards which could include a personal invitation from a staff member.

Orientation

Distinguishing orientation from invitation Participants considered ‘invitation’ as presenting rounds as an opportunity for family members to communicate with providers (i.e., ‘getting them there’). ‘Orientation’ then involves introducing the family member to the team, describing the structure of rounds, and outlining the role of family in rounds (i.e., ‘why they are there’).2) Ideal healthcare providers to orient family members to roundsParticipants discussed two main factors to assess which healthcare provider is most appropriate to orient family to rounds: (a) who is present when family is visiting, and (b) who has the most consistent presence at the bedside. This will most likely be the bedside nurse, although participants noted any healthcare provider can assume this role. Participants indicated that a standardized orientation would provide consistency. Information about rounds can also be placed in a welcome package or on a whiteboard in the patient’s room.