Intensive communication: Four-year follow-up from a clinical practice study
Intensive communication: Four-year follow-up from a clinical practice study
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DOI：
10.1097/01.ccm.0000065279.77449.b4
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发表时间：
2003-05-01
影响因子：
8.8
通讯作者：
Massaro, AF
中科院分区：
文献类型：
--
作者：
Lilly, CM;Sonna, LA;Massaro, AF
目的。确定改变做法的效果的持久性，这种改变的目的是在有益的情况下促进先进辅助技术的使用，但在无效的情况下限制其负担。我们已经在一项成人重症监护病房患者队列的前后研究中报道，建立密集沟通流程可以减少临终病人在重症监护病房的停留时间，并降低死亡率。我们现在报告这种干预措施延长4年的结果。材料和方法。对2361名连续进入大学三级护理医院的成人内科患者的咨询次数、重症监护病房住院时间和死亡率进行了测量。为了确定我们的干预效果的持久性，我们将我们在随后4年中的经验与密集沟通干预之前的134名患者和396名患者的经验进行了比较。我们在随后的实践中进行了与干预期间相同数量的密集沟通会议(每个住进重症监护病房的患者1.5次对1.6次)。然而，课程的持续时间往往较短，在我们后来的经验中，社会工作者、牧师和护理协调员的直接参与也较少。密集的沟通使住院时间显著和持久地减少(中位数住院时间，前4天[2-11天，四分位数范围]；研究期间3天[2-6天，四分位数范围]；随后3天[2-6天，四分位数范围])。我们的干预与重症监护病房死亡率的显著和持久的降低有关(干预前为31.3%，干预中为22.7%，干预后为18%；P<；.001)。密集的沟通与重症监护病房住院时间的持久减少和重症成人内科患者死亡率的降低有关。在干预之后，密集的沟通得到了更有效的应用，其有效性似乎并不依赖于非直接照顾者对会话的参与。这一过程鼓励对有生存潜力的患者继续使用先进的支持技术，并允许在先进支持技术无效时及早退出。
Purpose. To determine the durability of the effects of a change in practice designed to promote the use of advanced supportive technology when it is of benefit but to limit its burdens when it is ineffective. We have reported that institution of a process of intensive communication reduced length of intensive care unit stay for dying patients and reduced mortality in a before-and-after study in a cohort of patients admitted to an adult intensive care unit. We now report the results of a 4-yr extension of this intervention.Materials and Methods. The number of counseling sessions, intensive care unit length of stay, and mortality were measured for 2,361 adult medical patients consecutively admitted to a university tertiary care hospital. To determine the durability of the effects of our intervention, we compared our experience during the subsequent 4 yrs with that of the 134 consecutive patients before and 396 patients after our intensive communication intervention.Results. We conducted an equivalent number of intensive communication sessions in our subsequent practice as during the intervention (1.5 vs. 1.6 sessions per patient admitted to the intensive care unit). However, sessions tended to be of shorter duration, and direct participation by social workers, chaplains, and care coordinators was less frequent in our subsequent experience. Intensive communication produced a significant and durable reduction in length of stay (median length of stay, 4 days [2-11 days, interquartile range] before; 3 days [2-6 days, interquartile range] during the study; 3 days [2-6 days, interquartile range] subsequently). Our intervention was associated with a significant and durable reduction in intensive care unit mortality (31.3% before, 22.7% during the intervention, 18% subsequently; P < .001).Conclusions. Intensive communication is associated with durable reductions in intensive care unit length of stay and reduced mortality in critically ill adult medical patients. Intensive communication was applied more efficiently subsequent to the intervention, and its effectiveness does not seem to be dependent on nondirect caregivers' participation in the sessions. This process encourages the continuation of advanced supportive technology to patients with the potential to survive and allows the earlier withdrawal of advanced supportive technology when it is ineffective.