An intensive communication intervention for the critically ill

Lilly, Craig M.; Meo, Dawn L De; Sonna, Larry A.; Haley, Kathleen J.; Massaro, Anthony F.; Wallace, Robert F.; Cody, Sean

doi:10.1016/s0002-9343(00)00524-6

Cited by 468 publications

(319 citation statements)

References 18 publications

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“…Some evidence indicates that the use of regular structured meetings reduces ICU length of stay among patients with the highest acuity scores. 22 Ahrens and colleagues 28 evaluated the effects of a communication team (physicians and a clinical nurse specialist) versus usual care on length of stay and costs for patients near the end of life in the ICU. They reported that patients whose family members received intensive communication strategies had significantly shorter stays in the ICU and lower costs.…”

Section: Discussionmentioning

confidence: 99%

“…13,22,23 ICU family conferences within 72 hours have been associated with reduced number of days in the ICU for patients who die and with higher ratings of the quality of dying among family members. 22,23 The use of structured family conferences conducted by the usual ICU team improves patient-and family-centered outcomes, including emotional distress, processes of communication, and the frequency and timing of major treatments. 5 A preconference helps to get consensus on the prognosis and on what treatments are indicated.…”

Section: Planning the Interventionmentioning

confidence: 99%

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Improving Family Satisfaction and Participation in Decision Making in an Intensive Care Unit

Huffines

Johnson

Naranjo

et al. 2013

Critical Care Nurse

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Background Survey data revealed that families of patients in a surgical intensive care unit were not satisfied with their participation in decision making or with how well the multidisciplinary team worked together. Objectives To develop and implement an evidence-based communication algorithm and evaluate its effect in improving satisfaction among patients’ families. Methods A multidisciplinary team developed an algorithm that included bundles of communication interventions at 24, 72, and 96 hours after admission to the unit. The algorithm included clinical triggers, which if present escalated the algorithm. A pre-post design using process improvement methods was used to compare families’ satisfaction scores before and after implementation of the algorithm. Results Satisfaction scores for participation in decision making (45% vs 68%; z = −2.62, P = .009) and how well the health care team worked together (64% vs 83%; z = −2.10, P = .04) improved significantly after implementation. Conclusions Use of an evidence-based structured communication algorithm may be a way to improve satisfaction of families of intensive care patients with their participation in decision making and their perception of how well the unit’s team works together.

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Section: Discussionmentioning

confidence: 99%

Section: Planning the Interventionmentioning

confidence: 99%

Improving Family Satisfaction and Participation in Decision Making in an Intensive Care Unit

Huffines

Johnson

Naranjo

et al. 2013

Critical Care Nurse

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“…22,[29][30][31][32][33][34][35][36][37][38][39] Treatment of distressing symptoms by interdisciplinary palliative care and hospice teams translates to reduced medical complications and hospital utilization. 12,13,[40][41][42] In addition to symptom management, palliative care providers have expertise in the conduct of conversations with patients and families dedicated to assuring understanding of what to expect in the future, including prognosis and the resulting goals of care.…”

Section: Palliative Care and Hospicementioning

confidence: 99%

Research Priorities in Geriatric Palliative Care: Policy Initiatives

Unroe

Meier

2013

Journal of Palliative Medicine

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Coordinated palliative care matched to patient needs improves quality of care for vulnerable patients with serious illness and reduces costly use of hospitals and emergency departments. Unfortunately, there is a disconnect in translating geriatric palliative care models and principles into policy and widespread practice. Gaps in policy-relevant research are addressed, including implementation strategies to scale up existing care models, the role of palliative care and geriatrics in health care payment reform efforts, development of quality measures for complex patients, strategies to address workforce shortages, and an approach to hospice reform.''I told the doctor that I never wanted to go back to the hospital again. It's torture-you have no control and can't do anything for yourself. And you get weaker and sicker. Every time I'm in the hospital it feels like I'll never get out.'' This 88-year-old man with mild dementia presents to the emergency department for management of back pain due to spinal stenosis and arthritis. He had been admitted to the hospital four times in the past six months-twice for pain, once for weight loss and falls, and once for altered mental status due to constipation. His overwhelmed 83-year-old wife tells the emergency department physician, ''He hates being in the hospital, but what could I do? The pain was terrible and I couldn't reach the doctor. I couldn't even move him myself, so I called the ambulance. It was the only thing I could do.'' T he fields of palliative care and geriatrics have developed a growing body of evidence in support of customized care models aimed at meeting the needs of frail, vulnerable, and seriously ill patient populations. The problem is not that we don't know what to do-the problem is that we don't do what we know. The business of translating evidence into real-world practice for frail older adults is critically dependent on changes in public and payment policy. As in any aspect of health care, gaps do remain in our understanding of treatments and the optimal approach to delivering services to vulnerable populations. Allocation of research dollars to address these questions is an urgent public health priority. Health care spending in the United States not only fails to deliver quality but quite realistically poses the greatest threat to the American economy and way of life-the 18% of GDP in dollars spent on high cost, low value health care cannot be allocated to other crucial public needs: education, repair of roads and bridges, food and air quality and safety, and protection from the consequences of rising income inequality and poverty. The good news here is that improving quality of care for high risk, vulnerable patients-so that the patient described above does not have to turn to the emergency department for every symptom crisis, but instead receives coordinated palliative care matched to his changing needs at home-leads to much lower need for spending in emergency departments and hospitals. It is critical that federal, state, and local regulat...

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“…In this sense, many interventions have been tested to improve the quality of EOL care with different results. Ethics and palliative care consultations, intensive communication strategies, formal family conferences combined with the bereavement brochure have been demonstrated to improve the quality of EOL care by reducing the length of stay and the use inappropriate ICU resources, preventing conflicts and reducing psychological burden on family members [8][9][10][11]. Unfortunately, such interventions are still not widely adopted in ICUs [7].…”

mentioning

confidence: 99%

Physicians just need to be better trained to provide the best care at the end-of-life

Soares¹,

Piva

2012

Intensive Care Med

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Over the last decades, caring for terminally ill patients, either in the latter phases of progressive chronic diseases or in the setting of refractory organ failures in the course of acute critical illnesses, has become very frequent in intensive care units (ICUs) and such demand is expected to increase substantially in the next decades [1]. Although the end-of-life (EOL) decision-making process and the consequent strategy vary largely depending on several factors such as cultural aspects, religious beliefs, legal burdens, ethical and moral values, medical knowledge regarding terminally ill diseases and palliative care, up to three-quarters of all ICU deaths are preceded by limitations of treatment [2,3]. However, the care provided to patients at the EOL and their families needs to be urgently improved. Current information indicates that EOL care in ICUs is frequently inappropriate as a consequence of several factors including poor communication [4], inadequate symptom control [5] and divergence among the ICU team, families and the patients themselves regarding their expectations and values [6]. It is well known that conflicts in the context of EOL are perceived as much more severe and dangerous when compared to other conflicts [6].Several relevant barriers to improving EOL care at the levels of the patient/family (e.g. inability to participate in EOL discussions, lack of advance directives, unrealistic expectations), the clinician (e.g. both insufficient training in communication and expertise in symptom management, and competing demands on intensivists' time) and the hospital/institution (e.g. inadequacy or absence of local family conferences and lack of palliative care service) were raised by nurse and physician ICU directors in a survey involving 468 ICUs in the United States [7]. In this sense, many interventions have been tested to improve the quality of EOL care with different results. Ethics and palliative care consultations, intensive communication strategies, formal family conferences combined with the bereavement brochure have been demonstrated to improve the quality of EOL care by reducing the length of stay and the use inappropriate ICU resources, preventing conflicts and reducing psychological burden on family members [8][9][10][11]. Unfortunately, such interventions are still not widely adopted in ICUs [7]. On the other hand, the benefit of multifaceted quality improvement strategies remains unclear [12,13].In the current issue of Intensive Care Medicine, Forte et al. [14] present the results of a questionnaire submitted to 105 Brazilian ICU physicians selected from 11 ICUs in Intensive Care Med (2012) 38:342-344 DOI 10.1007/s00134-011-2432 EDITORIAL a university=affiliated hospital evaluating EOL decisions involving a hypothetical severely brain-damaged patient with no family members or advance directives The study has two major findings: (1) physicians who would not apply do-not-resuscitate (DNR) orders less frequently attended EOL classes; and (2) almost half of respondents would not proceed a...

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An intensive communication intervention for the critically ill

Cited by 468 publications

References 18 publications

Improving Family Satisfaction and Participation in Decision Making in an Intensive Care Unit

Improving Family Satisfaction and Participation in Decision Making in an Intensive Care Unit

Research Priorities in Geriatric Palliative Care: Policy Initiatives

Physicians just need to be better trained to provide the best care at the end-of-life

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