Relatives' perspectives on the quality of care in an Intensive Care Unit: The theoretical concept of a new tool

Objective: To examine the potential of a questionnaire (CQI 'R-ICU') to measure the quality of care from the perspective of relatives in the Intensive Care Unit (ICU). Methods: A quantitative survey study has been undertaken to explore the psychometric properties of the instrument, which was sent to 282 relatives of ICU patients from the Erasmus MC, an academic hospital in Rotterdam, the Netherlands. Factor-analyses were performed to explore the underlying theoretical structure. Results: Survey data from 211 relatives (response rate 78%) were used for the analysis. The overall reliability of the questionnaire was sufficiently high; two of the four underlying factors, namely 'Communication' and 'Involvement', were significant predictors. Two specific aspects of care that needed the most improvement were missing information about meals and offering an ICU diary. There is a significant difference in mean communication with nurses among the four wards in Erasmus MC. Conclusions: The CQI 'R-ICU' seems to be a valid, reliable and usable instrument. The theoretical fundament appears to be related to communication. Practice implications: The newly developed instrument can be used to provide feedback to health care professionals and policy makers in order to evaluate quality improvement projects with regard to relatives in the ICU.

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