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Improving Teamwork Within the Cardiac Intensive Care Unit to Enhance Family-Centered Communication
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By Atyia Collins

An intervention in the paediatric cardiac ICU to standardise pre-family meeting huddles is feasible, acceptable, and improves clinician teamwork

Introduction

Enhancing communication in the cardiac intensive care unit (CICU) can improve the quality of care for families and facilitate teamwork among interprofessional teams. Ineffective communication within clinical teams can negatively impact patient outcomes and result in families misinterpreting treatment.

To address this issue, a team of researchers, including Clinical Futures’ Core Faculty Members Jennifer Walter, MD, PhD, MS, and Chris Feudtner, MD, PhD, MPH, previously developed an intervention titled “CICU Teams and Loved Ones Communicating” (CICU TALC).  This intervention incorporates strategies to enhance how healthcare teams and families prepare for and conduct family meetings, as well as providing communication skills training for interprofessional teams.

The CICU TALC invention consists of six key components:

  1. A nurse facilitating a pre-family meeting huddle to discuss the goals of the FM and present preparation handouts.  
  2. Team preparedness meetings are held prior to FM.
  3. Assignment of four roles for the FM; facilitator, information provider, emotional support coordinator, and someone to document the discussion.
  4. Clinicians receive communication skills training focused on communicating and delivering serious news to families using a training model similar to Vital Talk type training.
  5. Interprofessional communication skills training is provided to clinicians to enhance teamwork in communication between the team and the family.

  6. Effective debrief training for clinicians reinforces skills and promotes future collaboration among team members.

    TALC CICU 6 STEPS

“The CICU TALC invention was developed to enhance clinicians' communication skills with each other and with families and prepare families for what to expect during the family meeting,” said Dr. Walter.

In a prior study electronically published in May 2024 in Pediatric Cardiology, titled "A Pediatric Interprofessional Cardiac Intensive Care Unit Intervention: CICU Teams and Loved Ones Communicating (CICU TALC) is Feasible, Acceptable, and Improves Clinician Communication Behaviors in Family Meetings" a team of researchers, including Clinical Futures’ Core Faculty Members Jennifer Walter, MD, PhD, MS, Karen M. Puopolo, MD, PhD, and Chris Feudtner, MD, PhD, MPH along with clinical research coordinator Arzu Cetin, MS, investigated the impact of this intervention on families. The results indicated that families found the intervention enhanced the quality of communication between them and the clinicians in the Cardiac Intensive Care Unit (CICU), helping families understand what to expect during family meetings.

The clinician-focused components of the CICU TALC intervention aim to optimize the skills and participation of all team members in both the pre-family meeting huddle and the subsequent family meeting. To evaluate the effects of these clinician-focused elements, a new study titled “An Intervention in the Paediatric Cardiac ICU to Standardise Pre-Family Meeting Huddles is Feasible, Acceptable, and Improves Clinician Teamwork” was conducted. This study included Clinical Futures’ Core Faculty Members Jennifer Walter, MD, PhD, MS, and Chris Feudtner, MD, PhD, MPH, along with clinical research coordinator Arzu Cetin, MS. The study was published online by the Cambridge University Press in February 2025.  

“Enhancing communication with families as well as communication within the clinical team are important factors in caring for patients in the CICU. Families are going through a stressful time worrying about their child, they need empathic communication and clear messages from the clinical team. Suboptimal communication within the clinical team can lead to conflicting messages to the family and result in misunderstanding of their child’s health status or even distrust toward the team,” said Dr. Walter, the study's principal investigator.

Study Design and Findings  

Researchers examined the feasibility, acceptability, and impact of the intervention on team performance. This study focused on the following outcomes:

Primary pilot trial outcomes:

  • Feasibility of enrolling clinicians in the intervention
  • Acceptability of the intervention
  • Fidelity of the intervention.  

Secondary outcome  

  • Impact of the intervention on clinician teamwork behaviors in pre-family meeting huddles.

The pretest-posttest pilot intervention study took place from 2018 to 2022 at the Children’s Hospital of Philadelphia (CHOP). The research team tracked participant eligibility, enrollment, data collection, completion rates, and fidelity to intervention protocol. Descriptive statistics were used to summarize quantitative acceptability, feasibility, and fidelity data. Clinician perceptions of the intervention's acceptability were assessed through a questionnaire and semi-structured interviews. The impact on team performance was evaluated using a validated tool, and Wilcoxon rank-sum tests were employed to compare teamwork ratings before and after the intervention.

Researchers utilized a mixed methods approach to analyze the clinician behaviors during pre-family meeting huddles. These huddles were audio-recorded and transcribed. The transcripts were assessed using the PACT novice observation form by trained members of the study team, with double coding performed on at least 20% of the transcripts.

Results showed that 96% of participants felt the intervention improved their participation in family meetings. Post-intervention ratings indicated strong acceptability, with all participants either strongly agreeing or agreeing that the training was effective, that it provided useful skills, and that they would recommend it to others. Clinicians also reported improvements in intra-team and team-family communication, as well as enhanced structure in the pre-family meeting huddles. However, some clinicians noted challenges in implementing new workflows due to competing time demands in the Critical Care Unit (CICU).

Research in Practice Implications  

Implementing an interprofessional team intervention in the pediatric cardiac ICU is not only feasible but can also be executed with impressive fidelity. This initiative is positively received by clinicians, significantly enhancing teamwork and communication during pre-family meeting huddles. Given these compelling results, further testing of the intervention's efficacy is essential to explore its broader impact on interprofessional collaboration, clinician communication, family engagement, and ultimately, patient outcomes.

“Despite the competing demands in the CICU, clinicians are willing to participate in additional training to improve their communication. There is awareness of the issues that suboptimal communication can cause and willingness to improve families’ experience in the CICU," said Dr. Walter.

Actionable Insights:  

  • Clinical: CICU TALC is an interprofessional team intervention for the pediatric CICU that is feasible to implement and can be done so with high fidelity. Evidence indicates that the intervention is acceptable to clinicians and improves teamwork.
  • Research: These results warrant future efficacy testing of the intervention for broader impacts on interprofessional teamwork, clinician communication skills, families, and patient outcomes
  • Advocacy/Policy: CICU TALC training has the potential for permanent integration into pediatric settings. 

Information and Resources:

Clinical Futures author(s): Jennifer Walter, Arzu Cetin, and Chris Feudtner.

Walter JK, Cetin A, Gramszlo C, et al. An intervention in the paediatric cardiac ICU to standardise pre-family meeting huddles is feasible, acceptable, and improves clinician teamwork. Cardiol Young. Published online February 7, 2025. doi:10.1017/S1047951125000010

  1. Walter JK, Hill D, Drust WA, et al. Intervention Codesign in the Pediatric Cardiac Intensive Care Unit to Improve Family Meetings. J Pain Symptom Manage. 2022;64(1):8-16. doi:10.1016/j.jpainsymman.2022.03.010
  2. Walter J, Hill DL, Cetin A, et al. A Pediatric Interprofessional Cardiac Intensive Care Unit Intervention: CICU Teams and Loved Ones Communicating (CICU TALC) is Feasible, Acceptable, and Improves Clinician Communication Behaviors in Family Meetings. Pediatr Cardiol. 2025;46(4):785-797. doi:10.1007/s00246-024-03497-7