A multifaceted intervention to improve compliance with process measures for ICU clinician communication with ICU
Martin D Black1, Margaret C Vigorito, J Randall Curtis
11Division of Pulmonary and Critical Care Medicine, Brown University School of Medicine, Providence, RI. 2Healthcentric Advisors, Providence, RI. 3Division of Pulmonary and Critical Care, Harborview Medical Center, University of Washington, Seattle, WA. 4Center for Biostatistics, The Ohio State University, Columbus, OH. 5Division of Palliative Care, Brown University School of Medicine, Providence, RI. 6Division of Geriatrics, Brown University School of Medicine, Providence, RI. 7Home and Hospice of Rhode Island, Providence, RI.
Rationale:
Despite recommendations supporting the importance of clinician-family communication in the ICU, this communication is often rated as suboptimal in frequency and quality. We employed a multifaceted behavioral-change intervention to improve communication between families and clinicians in a statewide collaboration of ICUs.
Objectives:
Our primary objective was to examine whether the intervention resulted in increased compliance with process measures that targeted clinician-family communication. As secondary objectives, we examined the ICU-level characteristics that might be associated with increased compliance (open vs closed, teaching vs nonteaching, and medical vs medical-surgical vs surgical) and patient-specific outcomes (mortality, length of stay).
Methods:
The intervention was a multifaceted quality improvement approach targeting process measures adapted from the Institute of Health Improvement and combined into two "bundles" to be completed either 24 or 72 hours after ICU admission.
Measurements And Main Results:
Significant increases were seen in full compliance for both day 1 and day 3 process measures. Day 1 compliance improved from 10.7% to 83.8% after 21 months of intervention (p<0.001). Day 3 compliance improved from 1.6% to 28.8% (p<0.001). Improvements in compliance varied across ICU type with less improvement in open, nonteaching, and mixed medical-surgical ICUs. Patient-specific outcome measures were unchanged, although there was a small increase in patients discharged from ICU to inpatient hospice (p=0.002).
Conclusions:
We found that a multifaceted intervention in a statewide ICU collaborative improved compliance with specific process measures targeting communication with family members. The effect of the intervention varied by ICU type.
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