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An intensive communication intervention for the critically ill.

C M Lilly1, D L De Meo, L A Sonna

  • 1Combined Program in Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.

The American Journal of Medicine
|October 24, 2000
PubMed
Summary
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Intensive communication reduced critical care length of stay, particularly for dying patients, by aligning care with patient goals and preferences. This approach improved resource utilization without increasing mortality.

Area of Science:

  • Critical care medicine
  • Medical ethics
  • Health services research

Background:

  • Advanced supportive technology in intensive care can be burdensome when ineffective.
  • Effective communication is crucial for aligning patient goals with care plans.
  • Proactive multidisciplinary communication can guide technology use based on patient outcomes.

Purpose of the Study:

  • To evaluate a communication strategy promoting beneficial use of advanced supportive technology and limiting ineffective burdens.
  • To compare usual care with a proactive, multidisciplinary communication method.
  • To identify criteria for care plan effectiveness and inform caregivers of patient preferences.

Main Methods:

  • A before-and-after study of 530 adult medical patients in a tertiary care hospital.

Related Experiment Videos

  • Multidisciplinary meetings within 72 hours of intensive care admission to discuss goals and milestones.
  • Tracking length of stay, mortality, and consensus before and after the communication intervention.

    • Main Results:

    • Intensive communication significantly reduced median intensive care length of stay from 4 to 3 days (P=0.01).
    • This reduction was significant after adjusting for APACHE 3 score (RR=0.81, P=0.04).
    • The benefit was most pronounced in the highest quartile of acuity patients who died (RR=0.60, P=0.02), with no increase in mortality.

    Conclusions:

    • Intensive communication effectively reduced critical care utilization in patients who died.
    • The multidisciplinary process optimized advanced supportive technology for survivors and facilitated earlier withdrawal for non-survivors.
    • This approach improved care alignment with patient goals and resource allocation.