ICU Physical Environments Used for Family Conferences: A Multimodal Qualitative Evaluation with ICU Team Members

OBJECTIVES: Family-clinician communication is central to high-quality care for critically ill patients. Although previous work has focused on improving how and what is communicated, little is known about where this high-stakes communication takes place and how it is shaped by the physical environment. Our objectives were to characterize ICU spaces typically used for family conferences and identify modifiable environmental features that influence communication. DESIGN: We conducted a multimodal qualitative study of 17 spaces typically used for family conferences across four adult ICUs in a U.S. academic medical center. Healthcare design and architecture experts independently assessed architectural plans and photographs to characterize spatial features. Then, we conducted semi-structured interviews with 23 ICU team members (nurses, social workers, case managers) to elicit perspectives on and experiences within these spaces. We conducted qualitative content analysis using a combined inductive and deductive approach. SETTING: A total of 17 family conference spaces across four adult ICUs in a U.S. academic medical center. PARTICIPANTS: A total of 23 ICU team members. INTERVENTIONS: None. RESULTS: The 17 analyzed spaces included designated family-communication rooms (n = 2), multipurpose rooms (n = 6), visitor lounges (n = 4), and public areas (n = 5; lobbies/hallways). Study participants preferred designated spaces, as they provide privacy, prevent interruption, and facilitate emotional support. Conversely, multipurpose and public areas are prone to distractions and interruptions from conflicting uses. We identified key environmental features that support communication: proximity to patients, flexible furniture layout, and nonclinical ambiance. CONCLUSIONS: Family conferences occur in a variety of physical environments in and around adult ICUs, ranging from intentionally designed rooms to elevator lobbies. ICU team members perceive that physical environments have an important influence on communication quality, and we identified pragmatic opportunities to improve existing spaces.