Family-Support Intervention in ICUs Increased Patient Comfort and Reduced Costs Interview with:

Douglas B. White, M.D., M.A.S. Director of the Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center’s Program on  Ethics and Decision Making in  Department of Critical Care Medicine University of Pittsburgh 

Dr. White

Douglas B. White, M.D., M.A.S.
Director of the Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center’s Program on
Ethics and Decision Making in  Department of Critical Care Medicine
University of Pittsburgh What is the background for this study? 

Response: We set out to test the effectiveness of PARTNER (PAiring Re-engineered ICU Teams with Nurse-driven Emotional Support and Relationship-building). PARTNER is delivered by the interprofessional team in the ICU, consisting of nurses, physicians, spiritual care providers, social workers and others who play a part in patient care. The program is overseen by nurse-leaders in each ICU who receive 12 hours of advanced communication skills training to support families. The nurses meet with the families daily and arrange interdisciplinary clinician-family meetings within 48 hours of a patient coming to the ICU. A quality improvement specialist helps to incorporate the family support intervention into the clinicians’ workflow.

PARTNER was rolled out at five UPMC ICUs with different patient populations and staffing. It was implemented in a staggered fashion so that every participating ICU would eventually get PARTNER. Before receiving PARTNER, the ICUs continued their usual methods of supporting families of hospitalized patients. None of the ICUs had a set approach to family communication or required family meetings at regular intervals before receiving PARTNER. A total of 1,420 adult patients were enrolled in the trial, and 1,106 of these patients’ family members agreed to be a part of the study and its six-month follow-up surveys. The patients were very sick, with about 60 percent dying within six months of hospitalization and less than 1 percent living independently at home at that point.  What are the main findings?

Response: Families who participated in the intervention were more likely to report that their loved one received patient-centered care – where the patient’s comfort, emotional well-being, beliefs and cultural needs were respected and guided clinical actions. Of those receiving PARTNER, 79.2 percent scored their loved one’s care in the highest patient-centeredness category on an assessment, compared to 63.2 percent of those who received usual care. The intervention cut the average hospital length-of-stay by more than three days, from 13.5 to 10.4 days, and shortened the average time patients spent in the ICU from 7.4 to 6.7 days.

During the trial, the program cost an average of $170 per patient, and it reduced costs by approximately $6,000 per patient. What should readers take away from your report?

Response: One in five Americans die in or shortly after discharge from an ICU – typically when a loved one decides to forego life-prolonging therapies. That difficult decision can be made unnecessarily stressful when there are problems with communication between a patient’s family and their care team. The PARTNER intervention helps the clinical team establish relationships and provide support to the family well before decisions have to be made about goals of care, which in turn leads to higher quality communication, more patient-centered care, shorter lengths of stay and less costly care at the end of life. What recommendations do you have for future research as a result of this work?

Response: A large replication trial is needed in multiple geographic regions to establish the generalizability of the findings in different health systems that have different practices regarding care for patients with advanced clinical illness. Is there anything else you would like to add?

Response: Additional authors on this research are Derek C. Angus, M.D., M.P.H., Anne-Marie Shields, M.S.N., R.N., Praewpannarai Buddadhumaruk, M.S., R.N., Caroline Pidro, B.S., Cynthia Paner, M.S.N., R.N., Elizabeth Chaitin, M.S.W., M.A., Chung-Chou H. Chang, Ph.D., Jeremy M. Kahn, M.D., M.S., Joseph M. Darby, M.D., Amy Kowinsky, R.D., L.D.N., Susan Martin, R.N., M.S.N., Robert M. Arnold, M.D., all of Pitt or UPMC, or both; Francis Pike, Ph.D., of Eli Lilly and Company; and Lisa Weissfeld, Ph.D., of the Statistics Collaborative, Inc., in Washington, D.C.

This research was funded by a UPMC Innovation Award and The Greenwall Foundation. 


A Randomized Trial of a Family-Support Intervention in Intensive Care Units

Douglas B. White, M.D., Derek C. Angus, M.D., M.P.H., Anne-Marie Shields, R.N., M.S.N., Praewpannarai Buddadhumaruk, R.N., M.S., Caroline Pidro, B.S., Cynthia Paner, R.N., M.S.N., Elizabeth Chaitin, M.S.W., D.H.C.E., Chung-Chou H. Chang, Ph.D., Francis Pike, Ph.D., Lisa Weissfeld, Ph.D., Jeremy M. Kahn, M.D., Joseph M. Darby, M.D., et al., for the PARTNER Investigators*
May 23, 2018
DOI: 10.1056/NEJMoa1802637

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Last Updated on May 30, 2018 by Marie Benz MD FAAD