Michael J Goldfarb1, Lior Bibas, Virginia Bartlett, Heather Jones, Naureen Khan. 1. 1Divisions of Cardiology and Critical Care, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA. 2Division of Cardiology, Department of Medicine, McGill University, Montreal, QC, Canada. 3Center for Healthcare Ethics, Cedars-Sinai Medical Center, Los Angeles, CA. 4Divisions of Pulmonary and Critical Care, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA. 5Division of Supportive Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
Abstract
OBJECTIVE: To determine whether patient- and family-centered care interventions in the ICU improve outcomes. DATA SOURCES: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library databases from inception until December 1, 2016. STUDY SELECTION: We included articles involving patient- and family-centered care interventions and quantitative, patient- and family-important outcomes in adult ICUs. DATA EXTRACTION: We extracted the author, year of publication, study design, population, setting, primary domain investigated, intervention, and outcomes. DATA SYNTHESIS: There were 46 studies (35 observational pre/post, 11 randomized) included in the analysis. Seventy-eight percent of studies (n = 36) reported one or more positive outcome measures, whereas 22% of studies (n = 10) reported no significant changes in outcome measures. Random-effects meta-analysis of the highest quality randomized studies showed no significant difference in mortality (n = 5 studies; odds ratio = 1.07; 95% CI, 0.95-1.21; p = 0.27; I = 0%), but there was a mean decrease in ICU length of stay by 1.21 days (n = 3 studies; 95% CI, -2.25 to -0.16; p = 0.02; I = 26%). Improvements in ICU costs, family satisfaction, patient experience, medical goal achievement, and patient and family mental health outcomes were also observed with intervention; however, reported outcomes were heterogeneous precluding formal meta-analysis. CONCLUSIONS: Patient- and family-centered care-focused interventions resulted in decreased ICU length of stay but not mortality. A wide range of interventions were also associated with improvements in many patient- and family-important outcomes. Additional high-quality interventional studies are needed to further evaluate the effectiveness of patient- and family-centered care in the intensive care setting.
OBJECTIVE: To determine whether patient- and family-centered care interventions in the ICU improve outcomes. DATA SOURCES: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library databases from inception until December 1, 2016. STUDY SELECTION: We included articles involving patient- and family-centered care interventions and quantitative, patient- and family-important outcomes in adult ICUs. DATA EXTRACTION: We extracted the author, year of publication, study design, population, setting, primary domain investigated, intervention, and outcomes. DATA SYNTHESIS: There were 46 studies (35 observational pre/post, 11 randomized) included in the analysis. Seventy-eight percent of studies (n = 36) reported one or more positive outcome measures, whereas 22% of studies (n = 10) reported no significant changes in outcome measures. Random-effects meta-analysis of the highest quality randomized studies showed no significant difference in mortality (n = 5 studies; odds ratio = 1.07; 95% CI, 0.95-1.21; p = 0.27; I = 0%), but there was a mean decrease in ICU length of stay by 1.21 days (n = 3 studies; 95% CI, -2.25 to -0.16; p = 0.02; I = 26%). Improvements in ICU costs, family satisfaction, patient experience, medical goal achievement, and patient and family mental health outcomes were also observed with intervention; however, reported outcomes were heterogeneous precluding formal meta-analysis. CONCLUSIONS:Patient- and family-centered care-focused interventions resulted in decreased ICU length of stay but not mortality. A wide range of interventions were also associated with improvements in many patient- and family-important outcomes. Additional high-quality interventional studies are needed to further evaluate the effectiveness of patient- and family-centered care in the intensive care setting.
Authors: Kirsten M Fiest; Henry T Stelfox; Anmol Shahid; Victoria S Owen; Bonnie G Sept; Shelly Longmore; Andrea Soo; Rebecca Brundin-Mather; Karla D Krewulak; Stephana J Moss; Kara M Plotnikoff; Céline Gélinas Journal: Pilot Feasibility Stud Date: 2022-07-16
Authors: Michael J Goldfarb; Christine Bechtel; Quinn Capers; Ann de Velasco; John A Dodson; Jamie L Jackson; Lisa Kitko; Ileana L Piña; Erin Rayner-Hartley; Nanette K Wenger; Martha Gulati Journal: J Am Heart Assoc Date: 2022-04-21 Impact factor: 6.106
Authors: Fernanda Lima-Setta; Daniela Porto Faus; Franciely Mario Carrijo Campos; Claudia Reis Miliauskas Journal: Rev Bras Ter Intensiva Date: 2019 Jan-Mar