Shortening the Family Satisfaction in the ICU (FS-ICU): Development and Validation of a 12-Item Family Satisfaction Survey for Adult ICUs

Objectives: To develop and validate a shorter Family Satisfaction in the ICU (FS-ICU) questionnaire that reduces survey length while preserving content and psychometric performance for quality improvement and benchmarking. The FS-ICU survey assesses family perceptions of care, communication, and decision-making and has been translated into multiple languages with implementation across diverse health care systems internationally. In a province-wide electronic implementation in Ontario, more than 40% of initiated surveys were incomplete, suggesting that survey length may limit practicality for large-scale quality improvement and benchmarking. Design: Multistage study using provincial FS-ICU survey data and an independent multicenter validation dataset for item reduction, psychometric evaluation, agreement testing, and external validation of a shortened questionnaire. Setting: A 12-member expert working group, convened for a Critical Care Services Ontario initiative, used provincial web-based data from adult ICUs across Ontario to develop a shorter version, FS-ICUshort. External validation was applied to FS-ICUshort using a separate multicenter Canadian revised FS-ICU dataset. Participants: A 12-member expert working group led by Dr. Daren K. Heyland, including administrative staff, ICU clinical staff, patient experience specialists, and quality improvement specialists from Ontario, used provincial FS-ICU rollout data. Interventions: None. Measurements and Main Results: Using empirical criteria and expert ratings, the FS-ICU was reduced from 29 to 12 items: seven in the satisfaction-with-care domain (FS-Care) and five in the communication and decision-making domain (FS-DM). FS-ICUshort showed high internal consistency (Cronbach’s α = 0.93 for FS-Care, 0.86 for FS-DM, and 0.94 for total). Confirmatory factor analysis supported a two-factor structure with better fit than a single-factor model. Scores from FS-ICUshort closely matched full FS-ICU, with mean differences less than or equal to 1.1 points on a 0–100 scale and intraclass correlations of 0.97–0.99. External validation replicated these results. Conclusions: The 12-item FS-ICUshort maintains the core content and psychometric quality of the original FS-ICU while significantly reducing length, supporting routine use in ICU family experience measurement and benchmarking.