A Multifaceted Intervention to Improve Compliance With Process Measures for ICU Clinician Communication With ICU Patients and Families
A Multifaceted Intervention to Improve Compliance With Process Measures for ICU Clinician Communication With ICU Patients and Families
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DOI：
10.1097/ccm.0b013e3182982671
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发表时间：
2013-10-01
影响因子：
8.8
通讯作者：
Levy, Mitchell M.
中科院分区：
文献类型：
--
作者：
Black, Martin D.;Vigorito, Margaret C.;Levy, Mitchell M.
理论基础：尽管建议支持ICU中临床医生-家庭沟通的重要性，但这种沟通在频率和质量上通常被评为次优。在全州范围的ICU合作中，我们采用了多方面的行为改变干预措施来改善家庭和临床医生之间的沟通。目的：我们的主要目标是检查干预是否导致对针对临床医生与家庭沟通的流程措施的遵从性增加。作为次要目标，我们检查了ICU水平的特征，这些特征可能与提高依从性(开放与封闭，教学与非教学，内科与内科-外科与外科)以及患者特定的结果(死亡率，住院时间)有关。方法：干预是一种多方面的质量改进方法，目标是从健康改善研究所改编的过程措施，并合并成两个捆绑，在ICU入院24或72小时后完成。测量和主要结果：在第一天和第三天的过程措施中，完全遵从性显著增加。干预21个月后，第一天依从性从10.7%提高到83.8%(P<；0.001)。第三天的遵从性从1.6%提高到28.8%(p<；0.001)。依从性的改善因ICU类型而异，开放式、非教学型和内外科混合型ICU的改善较小。患者特定的结果指标没有变化，尽管从ICU出院到住院临终关怀的患者略有增加(p=0.002)。结论：我们发现，在全州范围内的ICU协作中进行多方面的干预，可以改善针对与家庭成员沟通的特定流程措施的遵从性。干预效果因ICU类型不同而异。
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.