The Critical Care Communication project: Improving fellows' communication skills

Arnold, Robert M.; Back, Anthony L.; Barnato, Amber E.; Prendergast, Thomas J.; Emlet, Lillian L.; Karpov, Irina; White, Patrick H.; Nelson, Judith E.

doi:10.1016/j.jcrc.2014.11.016

Cited by 113 publications

(93 citation statements)

References 23 publications

(12 reference statements)

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“…Furthermore, our results highlight the urgency of developing a multifaceted approach to address the increasing intensity of care for the growing population of patients with advanced dementia. Such an approach will need to align clinical care and financial incentives with patients’ informed preferences and provide the needed education and training for health care professionals 24 to ensure that decisions to use mechanical ventilation in persons with advanced dementia are based on high-quality shared decision making that incorporates the goals of care of informed patients and their families.…”

Section: Discussionmentioning

confidence: 99%

Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds

et al. 2016

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IMPORTANCE Mechanical ventilation may be lifesaving, but in certain persons, such as those with advanced dementia, it may prolong patient suffering without a clear survival benefit. OBJECTIVE To describe the use and outcomes of mechanical ventilation and its association with the increasing numbers of intensive care unit (ICU) beds in the United States for patients with advanced dementia residing in a nursing home 120 days before that hospital admission. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study evaluated Medicare beneficiaries with advanced dementia hospitalized from January 1, 2000, to December 31, 2013, using the Minimum Data Set assessments linked with Medicare part A claims. A hospital fixed-effect, multivariable logistic regression model examined the effect of changes in ICU beds within individual hospitals and the likelihood of receiving mechanical ventilation, controlling for patients' demographic characteristics, function, and comorbidities. MAIN OUTCOMES AND MEASURES Mechanical ventilation.RESULTS From 2000 to 2013, a total of 635 008 hospitalizations of 380 060 eligible patients occurred (30.5% male and 69.5% female; mean [SD] age, 84.4 [7.4] years). Use of mechanical ventilation increased from 39 per 1000 hospitalizations in 2000 to 78 per 1000 hospitalizations in 2013 (P < .001, test of linear trend). As the number of ICU beds in a hospital increased over time, patients with advanced dementia were more likely to receive mechanical ventilation (ie, adjusted odds ratio per 10 ICU bed increase, 1.06; 95% CI, 1.05-1.07). In 2013, hospitals in the top decile in the number of ICU beds were reimbursed $9611.89 per hospitalization compared with $8050.24 per hospitalization in the lower decile (P < .001) without an improvement in 1-year mortality (65.2% vs 64.6%; P = 54).CONCLUSIONS AND RELEVANCE Among hospitalized nursing home residents with advanced dementia, we found an increase in the use of mechanical ventilation over time without substantial improvement in survival. This increase in the use of mechanical ventilation was associated with an increase in the number of ICU beds within a hospital.

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Section: Discussionmentioning

confidence: 99%

Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds

et al. 2016

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“…Moreover the single site study limits results' generalizability. This study design—frequently adopted in research testing the feasibility and potential impact of educational interventions (Hulsman et al, 1999; Berger et al, 2010; Lamiani et al, 2011; Meyer et al, 2011; Bartels et al, 2013; Ledford et al, 2014; Arnold et al, 2015; Shah et al, 2015; Robinson et al, 2016; Viau et al, 2016) is appropriate for the demonstration of feasibility and for initial proof of concept, it is cost effective, and it is pragmatic because it allows for “real world” variability in variables. Consistent with the intent of a pilot study, our goal was to examine feasibility and potential impact.…”

Section: Discussionmentioning

confidence: 99%

An Educational Intervention to Train Professional Nurses in Promoting Patient Engagement: A Pilot Feasibility Study

et al. 2017

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Introduction: Growing evidence recognizes that patients who are motivated to take an active role in their care can experience a range of health benefits and reduced healthcare costs. Nurses play a critical role in the effort to make patients fully engaged in their disease management. Trainings devoted to increase nurses' skills and knowledge to assess and promote patient engagement are today a medical education priority. To address this goal, we developed a program of nurse education training in patient engagement strategies (NET-PES). This paper presents pilot feasibility study and preliminary participants outcomes for NET-PES.Methods: This is a pilot feasibility study of a 2-session program on patient engagement designed to improve professional nurses' ability to engage chronic patients in their medical journey; the training mainly focused on passing patient engagement assessment skills to clinicians as a crucial mean to improve care experience. A pre-post pilot evaluation of NET-PES included 46 nurses working with chronic conditions. A course specific competence test has been developed and validated to measure patient engagement skills. The design included self-report questionnaire completed before and after the training for evaluation purposes. Participants met in a large group for didactic presentations and then they were split into small groups in which they used role-play and case discussion to reflect upon the value of patient engagement measurement in relation to difficult cases from own practice.Results: Forty-six nurses participated in the training program. The satisfaction questionnaire showed that the program met the educational objectives and was considered to be useful and relevant by the participants. Results demonstrated changes on clinicians' attitudes and skills in promoting engagement. Moreover, practitioners demonstrated increases on confidence regarding their ability to support their patients' engagement in the care process.Conclusions: Learning programs teaching nurses about patient engagement strategies and assessment measures in clinical practice are key in supporting the realization of patient engagement in healthcare. Training nurses in this area is feasible and accepted and might have an impact on their ability to engage patients in the chronic care journey. Due to the limitation of the research design, further research is needed to assess the effectiveness of such a program and to verify if the benefits envisaged in this pilot are maintained on a long-term perspective and to test results by employing a randomized control study design.

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“…14,15 For example, a three day course using simulated patients and immediate feedback increases critical care fellows’ self-reported family meeting communication skills. 42 …”

Section: Discussionmentioning

confidence: 99%

Conflict Management Strategies in the ICU Differ Between Palliative Care Specialists and Intensivists

Chiarchiaro

White

Ernecoff

et al. 2016

Critical Care Medicine

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OBJECTIVE Conflict is common between physicians and surrogate decision makers around end-of-life care in intensive care units (ICU). Involving experts in conflict management improve outcomes, but little is known about what differences in conflict management styles may explain the benefit. We used simulation to examine potential differences in how palliative care specialists manage conflict with surrogates about end-of-life treatment decisions in ICUs compared with intensivists. DESIGN Subjects participated in a high-fidelity simulation of conflict with a surrogate in an ICU. In this simulation, a medical actor portrayed a surrogate decision maker during an ICU family meeting who refuses to follow an advance directive that clearly declines advanced life-sustaining therapies. We audio-recorded the simulation encounters and applied a coding framework to quantify conflict management behaviors, which was organized into two categories: task-focused communication and relationship-building. We used negative binomial modeling to determine whether there were differences between palliative care specialists’ and intensivists’ use of task-focused communication and relationship building. SETTING Single academic medical center ICU PARTICIPANTS Palliative care specialists and intensivists INTERVENTIONS none MEASUREMENTS and MAIN RESULTS We enrolled 11 palliative care specialists and 25 intensivists. The palliative care specialists were all attending physicians. The intensivist group consisted of 11 attending physicians, 9 pulmonary and critical care fellows, and 5 internal medicine residents rotating in the intensive care unit. We excluded the 5 residents from the primary analysis in order to reduce confounding due to training level. Physicians’ mean age was 37 years with a mean of 8 years in practice. Palliative care specialists used 55% fewer task-focused communication statements (Incidence Rate Ratio 0.55, 95% CI 0.36–0.83, p= 0.005) and 48% more relationship building statements (Incidence Rate Ratio 1.48, 95% CI 0.89–2.46, p=0.13) compared with intensivists. CONCLUSIONS We found that palliative care specialists engage in less task-focused communication when managing conflict with surrogates compared to intensivists. These differences may help explain the benefit of palliative care involvement in conflict and could be the focus of interventions to improve clinicians’ conflict resolution skills.

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The Critical Care Communication project: Improving fellows' communication skills

Cited by 113 publications

References 23 publications

Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds

Association of Increasing Use of Mechanical Ventilation Among Nursing Home Residents With Advanced Dementia and Intensive Care Unit Beds

An Educational Intervention to Train Professional Nurses in Promoting Patient Engagement: A Pilot Feasibility Study

Conflict Management Strategies in the ICU Differ Between Palliative Care Specialists and Intensivists

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