Clinical studyAn intensive communication intervention for the critically ill☆
Section snippets
Study design
In a prospective, nonblinded, change-of-practice intervention study, we measured ICU, hospital, and rehabilitation facility mortality rates; probability of remaining in the ICU as a function of time after admission; and survival to discharge from acute and rehabilitative care to home, skilled nursing, or chronic care facilities for 530 consecutive adult patients admitted to a general medical ICU in a tertiary care teaching hospital. We made our intervention in a 10-bed unit in which all
Results
The 134 patients in the preintervention group and the 396 patients in the intensive communication group had similar age, race, sex, and mean (Table 1)and median (Figure 1) APACHE 3 scores.
A greater percentage of attending physician–led meetings were held in the intensive communication period than in the preintervention period [273 of 396 (69%) vs 58 of 134 (43%), P <0.001]. Multidisciplinary meetings occurred with 270 (68%) of 396 intensive communication patients or their families within 72
Discussion
We undertook this intensive communication intervention to improve care for critically ill adult medical patients by encouraging advanced supportive technology when it was effective for accomplishing patient-directed goals and limiting it when ineffective. We confirmed that critical care effectively restores life and function in the majority of critically ill adults 1, 4, 15, 16, 17, 18, and we found that intensive communication accomplished this goal with greater concordance among patients,
Acknowledgements
The authors would like to recognize the tireless efforts of Father George Winchester, Carol Smith, Barbara Collishaw, and the Brigham and Women’s Hospital medical intensive care unit nurses for their support of critically ill patients and families. This study was supported by the Brigham and Women’s Hospital.
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Supported by Brigham and Women’s Hospital.