The effect of a family support intervention on family satisfaction, length-of-stay, and cost of care in the intensive care unit

Shelton, Wayne; Moore, Crystal Dea; Socaris, Sophia; Gao, Jian; Dowling, Jane

doi:10.1097/ccm.0b013e3181d9d9fe

Cited by 64 publications

(80 citation statements)

References 23 publications

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“…Shelton et al (34) evaluated the effect of adding a full-time family support coordinator to a surgical ICU team in a pre-post study design; no differences in LOS were observed in the pre versus postimplementation period (11.8 d vs 11.4 d, respectively, p = 0.89). In a patient-targeted intervention, Daly et al (35) enrolled patients from five different ICUs and evaluated the effectiveness of an intensive communication strategy in a pre-post design; there were no significant differences in ICU LOS (13.4 d vs 14.4 d, pre vs post, respectively; p = 0.16).…”

Section: Resultsmentioning

confidence: 99%

“…Third, intervention targets varied between studies (patient vs system). For example, two of the trials reporting no difference in LOS involved system-level interventions with patient-level outcomes, which could potentially attenuate the effect seen on ICU LOS (27, 34). For these reasons, we separated interventions by setting and level of the intervention target.…”

Section: Discussionmentioning

confidence: 99%

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Estimating the Effect of Palliative Care Interventions and Advance Care Planning on ICU Utilization

Khandelwal

Kross

Engelberg

et al. 2015

Critical Care Medicine

259

161

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Objective We conducted a systematic review to answer three questions: 1) Do advance care planning and palliative care interventions lead to a reduction in ICU admissions for adult patients with life-limiting illnesses? 2) Do these interventions reduce ICU length of stay? and 3) Is it possible to provide estimates of the magnitude of these effects? Data Sources We searched MEDLINE, EMBASE, Cochrane Controlled Clinical Trials, and Cumulative Index to Nursing and Allied Health Literature databases from 1995 through March 2014. Study Selection We included studies that reported controlled trials (randomized and nonrandomized) assessing the impact of advance care planning and both primary and specialty palliative care interventions on ICU admissions and ICU length of stay for critically ill adult patients. Data Extraction Nine randomized controlled trials and 13 nonrandomized controlled trials were selected from 216 references. Data Synthesis Nineteen of these studies were used to provide estimates of the magnitude of effect of palliative care interventions and advance care planning on ICU admission and length of stay. Three studies reporting on ICU admissions suggest that advance care planning interventions reduce the relative risk of ICU admission for patients at high risk of death by 37% (sd, 23%). For trials evaluating palliative care interventions in the ICU setting, we found a 26% (sd, 23%) relative risk reduction in length of stay with these interventions. Conclusions Despite wide variation in study type and quality, patients who received advance care planning or palliative care interventions consistently showed a pattern toward decreased ICU admissions and reduced ICU length of stay. Although sds are wide and study quality varied, the magnitude of the effect is possible to estimate and provides a basis for modeling impact on healthcare costs.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Estimating the Effect of Palliative Care Interventions and Advance Care Planning on ICU Utilization

Khandelwal

Kross

Engelberg

et al. 2015

Critical Care Medicine

259

161

View full text Add to dashboard Cite

show abstract

“…Various approaches to improve the communication and decision-making have been presented recently. Shelton et al [63 ] showed that the introduction of a family support coordinator increased family satisfaction in their ICU. As the authors point out, the main task of the coordinator was to serve as liaison between the patient's family and the healthcare team.…”

Section: Communication and Decision-makingmentioning

confidence: 98%

Family satisfaction with critical care: measurements and messages

Rothen¹,

Stricker

Heyland

2010

Current Opinion in Critical Care

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“…In a multi-center cluster RCT conducted by Curtis et al, a quality improvement intervention targeted at hospitals and clinicians to integrate palliative care in the ICU also did not result in a significant decrease in LOS (18). Shelton et al evaluated the effect of adding a full-time family support coordinator to a surgical ICU team in a pre-post study design; no differences in LOS were observed in the pre versus post-implementation period (19). Lastly, Daly et al enrolled patients from 5 different ICUs and evaluated the effectiveness of an intensive communication strategy involving proactive multidisciplinary family conferences using a pre-post design; there were no significant differences in ICU LOS (20).…”

Section: Studies Reporting On Icu Losmentioning

confidence: 99%

Economic implications of end-of-life care in the ICU

Curtis

2014

Current Opinion in Critical Care

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Purpose of review Advance care planning and palliative care interventions can improve the quality of end-of-life care by reducing unwanted high intensity care at the end of life. This may have important economic implications and may reduce financial burden of patients' families. We review the literature to examine the impact advance care planning and palliative care have on ICU utilization, specifically ICU admissions and ICU LOS, to provide insight into ways to reduce costs and financial burden of care while simultaneously improving quality of care. Recent findings We identified 3 studies assessing the impact of palliative care consultation on ICU admissions for patients with life-limiting illness; all 3 demonstrate reduced ICU admissions for patients receiving palliative care consultation. Among 16 studies evaluating ICU LOS as an outcome, 5 report no change and 11 report decrease in LOS for patients receiving advance care planning or palliative care. These studies are heterogeneous in design and target population; however, a trend towards reduced ICU utilization exists. Summary Advance care planning and palliative care can reduce ICU utilization at the end of life. The degree to which reducing ICU utilization decreases emotional and financial burden of end-of-life care for patients and families is unknown.

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The effect of a family support intervention on family satisfaction, length-of-stay, and cost of care in the intensive care unit

Cited by 64 publications

References 23 publications

Estimating the Effect of Palliative Care Interventions and Advance Care Planning on ICU Utilization

Estimating the Effect of Palliative Care Interventions and Advance Care Planning on ICU Utilization

Family satisfaction with critical care: measurements and messages

Economic implications of end-of-life care in the ICU

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