A Quality Improvement Initiative to Achieve Provincial Implementation of a Web-Based Family Satisfaction in ICU (FS-ICU) Survey to Inform Patient-Centered Care

OBJECTIVES: To review the web-based Family Satisfaction in ICU (FS-ICU) survey across all adult level 3 Ontario ICUs to capture patient and family experiences with critical care, and to evaluate feasibility, participation, and satisfaction scores. DESIGN: A province-wide, multisite quality improvement study using an electronic, key-based FS-ICU survey with prospectively collected anonymous data linked to encounters through a centralized database. SETTING: All 83 adult level 3 ICUs (52 community, 31 academic) in ON, Canada, from July 1, 2019, to May 31, 2024. PATIENTS: The population comprised adult ICU patients, family members, or substitute decision-makers, with one survey per ICU encounter regardless of length of stay or number of family members. INTERVENTIONS: ICUs implemented a web-based FS-ICU using a unique seven-digit key in three formats (Staff-Provided, Quick Response-Driven, Website-Code), supported by training, resources, and tablets, with no clinical care interventions beyond routine practice. MEASUREMENTS AND MAIN RESULTS: Feasibility metrics included onboarding (keys generated per ICU admission), opening, participation, and completion rates, calculated for different centers using provincial data. Over the study period, 24,679 unique keys were generated for 353,400 ICU admissions (onboarding rate, 7.0%), 13,596 keys were opened (opening rate, 55.1%), and 7,542 surveys met the greater than or equal to 70% completion threshold (completion rate, 57.6% among opened surveys; reflection rate, 2.1% of ICU encounters). Survey initiation was highest with the Staff-Provided format (88.4% of keys initiated), and overall satisfaction was high, with mean FS with Care, 87.8; FS with Decision-Making, 84.4; and FS-TOTAL 86.5 on a 0-100 scale, with nursing care rated highest and adequacy of time for questions rated lowest. CONCLUSIONS: A provincial, web-based FS-ICU was implemented across all adult level 3 Ontario ICUs, producing a large dataset with high satisfaction scores. A small proportion completed the survey, highlighting feasibility and workflow barriers. Future efforts should improve activation and completion rates and integrate FS-ICU data into routine quality improvement to enhance patient- and family-centered care.