Assessing the intangible

October 03, 2016

Treating patients and their family members with respect and dignity is essential to excellent medical care; yet, unlike other elements of high-quality care, respect and dignity are difficult to define, let alone measure. In an effort to promote patients being treated with respect and dignity, bioethics scholars at Johns Hopkins created a 10-point checklist to assess key components of respect and dignity in the intensive care unit (ICU) setting.

"Given the demands of critical care, it is possible to lose track of treating patients and family members with respect and dignity, but we believe that this is an essential aspect of high-quality care. So we thought it was important to figure out how to measure it, with the idea that careful assessment could identify areas in need of improvement," says Joseph Carrese of the Johns Hopkins Berman Institute of Bioethics, lead author of the study introducing the new checklist, published in Critical Care Medicine.

The checklist is the result of data obtained by direct observation of patient-clinician encounters in seven ICUs within the Johns Hopkins Health System in Baltimore, MD. Overall, 351 encounters were observed, with 184 different patients. The assessment of respect and dignity is broken down into 10 items within two general domains: clinician behavior (e.g., greeting patients; explaining activities; and being responsive to patient needs/requests) and clinician demeanor (e.g., being pleasant, compassionate, and supportive).

A key finding of the study was statistically significant differences in mean checklist scores between different types of ICUs, which the authors say could indicate that units caring for only one type of medical problem (e.g., neurological ICUs), do better than units caring for "all comers", perhaps due to staff training, expertise or familiarity with their patients' conditions.

The immediate next step, Carrese says, is to test the checklist in other settings. "We hope that other institutions and researchers will conduct further research in this area, to see if the results we found here, in our large urban health system in the Mid-Atlantic region, can be reproduced elsewhere. This study is an important but early step in ensuring excellent medical care," Carrese says.
Critical Care Medicine: "A Direct Observation Checklist to Measure Respect and Dignity in the ICU"

Authors: Joseph A. Carrese, MD, MPH; Gail Geller, ScD, MHS; Emily D. Branyon, MA; Lindsay K. Forbes, BA; Rachel J. Topazian, BA; Brian W. Weir, PhD, MHS, MPH;Omar Khatib; Jeremy Sugarman, MD, MPH, MA.

Link to article:

About the Johns Hopkins Berman Institute of Bioethics:

One of the largest bioethics centers in the world, the Johns Hopkins Berman Institute of Bioethics is the home for collaborative scholarship and teaching on the ethics of clinical practice, public health and biomedical science at Johns Hopkins University. Since 1995, the Institute has worked with governmental agencies, nongovernmental and private sector organizations to address and resolve ethical issues. Institute faculty members represent diverse disciplines including medicine, nursing, law, philosophy, public health and the social sciences. More information is available at

Johns Hopkins Medicine

Related Critical Care Articles from Brightsurf:

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

New strategies suggested for critical heart care in the ICU
Critically ill heart patients are at increased risk of complications that are potentially preventable and associated with death, longer hospital stays and higher costs.

Capital funding of health care in Canada is critical, yet declined in last 20 years
Capital funding of health care, used to build new hospitals, redesign or upgrade existing facilities and invest in new technologies, has declined in Canada over the last 20 years, according to an analysis in CMAJ (Canadian Medical Association Journal)

Mortality of mechanically ventilated COVID-19 patients is lower than previously reported reveals study in Critical Care Medicine
An online first study published in Critical Care Medicine indicates the actual mortality rate of adults with critical illness from COVID-19 is less than what was previously reported.

COVID-19 critical care bed modelling study: potential shortage in Canada
A national modelling paper predicting the number of available ICU beds across Canada during the COVID-19 pandemic suggests that self-isolation will likely not be enough to keep demand from exceeding supply.

Covid-19 tool allows health leaders to plan for critical care surge
The challenges of COVID-19 will require hospital leaders, practitioners and regional officials to adopt drastic measures that challenge the standard way of providing care.

Critical care surgery team develops blueprint for essential operations during COVID-19
To help guide hospital surgery departments through this crisis, the acute surgery division at Atrium Health's Carolinas Medical Center in Charlotte, N.C., has developed a tiered plan for marshaling limited resources.

Study: Critical care improvements may differ depending on hospital's patient population
A new study led by researchers at Beth Israel Deaconess Medical Center reveals that while critical care outcomes in ICUs steadily improved over a decade at hospitals with few minority patients, ICUs with a more diverse patient population did not progress comparably.

Study finds disparity in critical care deaths between non-minority and minority hospitals
While deaths steadily declined over a decade in intensive care units at hospitals with few minority patients, in ICUs with large numbers of minority patients, there was less improvement, according to new research published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

Hospital critical care resuscitation unit improves patients' chances of survival
Patients with acutely life-threatening health conditions who were treated in the innovative Critical Care Resuscitation Unit (CCRU) received faster treatment and had better health outcomes, including a 36 percent lower risk of dying than those who were transferred from a hospital's emergency department then evaluated and treated in a traditional intensive care unit, according to a recent study in the Journal of Emergency Medicine conducted by researchers at the University of Maryland School of Medicine.

Read More: Critical Care News and Critical Care Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to