A Multifaceted Intervention To Improve Communication In The ICU

Black, Martin D.; Levy, Mitchell M.; McNicholl, Lynn; Cornell, Margaret

doi:10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a4121

Cited by 1 publication

(1 citation statement)

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“…This challenge is not specific to the Four Supports Intervention, has been noted in several other studies, 40,41 and has proven resistant to quality improvement interventions. 21,58 We successfully addressed this problem by giving more advanced notice to these clinicians and arranging meetings at times that were feasible for clinicians, as well as through persistent advocacy for the needs of the family. Another approach to address this—that should be explored in future research—is for the FSS to take on even more responsibility for communication.…”

Section: Discussionmentioning

confidence: 99%

Nurse-Led Intervention to Improve Surrogate Decision Making for Patients with Advanced Critical Illness

White¹,

Martin²,

Walk³

et al. 2012

American Journal of Critical Care

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Background Problems persist with surrogate decision making in intensive care units, leading to distress for surrogates and treatment that may not reflect patients’ values. Objectives To assess the feasibility, acceptability, and perceived effectiveness of a multifaceted, nurse-led intervention to improve surrogate decision making in intensive care units. Study Design A single-center, single-arm, interventional study in which 35 surrogates and 15 physicians received the Four Supports Intervention, which involved incorporating a family support specialist into the intensive care team. That specialist maintained a longitudinal relationship with surrogates and provided emotional support, communication support, decision support, and anticipatory grief support. A mixed-methods approach was used to evaluate the intervention. Results The intervention was implemented successfully in all 15 patients, with a high level of completion of each component of the intervention. The family support specialist devoted a mean of 48 (SD 36) minutes per day to each clinician-patient-family triad. All participants reported that they would recommend the intervention to others. At least 90% of physicians and surrogates reported that the intervention (1) improved the quality and timeliness of communication, (2) facilitated discussion of the patient’s values and treatment preferences, and (3) improved the patient-centeredness of care. Conclusions The Four Supports Intervention is feasible, acceptable, and was perceived by physicians and surrogates to improve the quality of decision making and the patient-centeredness of care. A randomized trial is warranted to determine whether the intervention improves patient, family, and health system outcomes.

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