Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 8/2019

01-08-2019 | Care | Systematic Review

Intensive care unit length of stay is reduced by protocolized family support intervention: a systematic review and meta-analysis

Authors: Hyun Woo Lee, Yeonkyung Park, Eun Jin Jang, Yeon Joo Lee

Published in: Intensive Care Medicine | Issue 8/2019

Login to get access

Abstract

Purpose

This study aimed to elucidate the impact of protocolized family support intervention on length of stay (LOS) in the intensive care unit (ICU) through a systematic review and meta-analysis.

Methods

Medline, EMBASE, the Cochrane Central Register of Controlled Trials, and other web-based databases were referenced since inception until November 26, 2018. We included randomized-controlled trials wherein protocolized family support interventions were conducted for enhanced communication and shared medical decision-making. LOS (in days) and mortality were evaluated using a random-effects model, and adjusted LOS was estimated using a mixed-effects model.

Results

We included seven randomized-controlled trials with 3477 patients. Protocolized family support interventions were found to significantly reduce the ICU LOS {mean difference = − 0.89 [95% confidence interval (CI) = − 1.50 to − 0.27]} and hospital LOS [mean difference = − 3.78 (95% CI = − 5.26 to − 2.29)]; the results of the mixed-effect model showed that they significantly reduced ICU LOS after adjusting for the therapeutic goal [mean difference = − 1.30 (95% CI = − 2.35 to − 0.26)], methods of measurement [mean difference = − 0.89 (95% CI = − 1.55 to − 0.22)], and timing of intervention [mean difference = − 1.05 (95% CI = − 2.05 to − 0.05)]. Similar results were found after adjusting for patients’ disease severity [mean difference = − 1.21 (95% CI = − 2.03 to − 0.39)] and the trim-and-fill method [mean difference = − 0.86 (95% CI = − 1.44 to − 0.28)]. There was no difference in mortality rate in ICU and hospital between the protocolized intervention and control groups.

Conclusions

Protocolized family support intervention for enhanced communication and shared decision-making with the family reduced ICU LOS in critically ill patients without impacting mortality.
Appendix
Available only for authorised users
Literature
1.
Kynoch K, Chang A, Coyer F, McArdle A (2016) The effectiveness of interventions to meet family needs of critically ill patients in an adult intensive care unit: a systematic review update. JBI Database Syst Rev Implement Rep 14:181–234CrossRef
2.
Goldfarb MJ, Bibas L, Bartlett V, Jones H, Khan N (2017) Outcomes of patient- and family-centered care interventions in the ICU: a systematic review and meta-analysis. Crit Care Med 45:1751–1761CrossRef
3.
Kyeremanteng K, Gagnon LP, Thavorn K, Heyland D, D’Egidio G (2018) The impact of palliative care consultation in the ICU on length of stay: a systematic review and cost evaluation. J Intensive Care Med 33:346–353CrossRef
4.
Wendler D, Rid A (2011) Systematic review: the effect on surrogates of making treatment decisions for others. Ann Intern Med 154:336–346CrossRef
5.
Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, Annane D, Bleichner G, Bollaert PE, Darmon M, Fassier T, Galliot R, Garrouste-Orgeas M, Goulenok C, Goldgran-Toledano D, Hayon J, Jourdain M, Kaidomar M, Laplace C, Larche J, Liotier J, Papazian L, Poisson C, Reignier J, Saidi F, Schlemmer B (2005) Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 171:987–994CrossRef
6.
Gries CJ, Engelberg RA, Kross EK, Zatzick D, Nielsen EL, Downey L, Curtis JR (2010) Predictors of symptoms of posttraumatic stress and depression in family members after patient death in the ICU. Chest 137:280–287CrossRef
7.
Kon AA, Davidson JE, Morrison W, Danis M, White DB (2016) Shared decision making in ICUs: an American College of critical care medicine and american thoracic society policy statement. Crit Care Med 44:188–201CrossRef
8.
Davidson JE, Aslakson RA, Long AC, Puntillo KA, Kross EK, Hart J, Cox CE, Wunsch H, Wickline MA, Nunnally ME, Netzer G, Kentish-Barnes N, Sprung CL, Hartog CS, Coombs M, Gerritsen RT, Hopkins RO, Franck LS, Skrobik Y, Kon AA, Scruth EA, Harvey MA, Lewis-Newby M, White DB, Swoboda SM, Cooke CR, Levy MM, Azoulay E, Curtis JR (2017) Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med 45:103–128CrossRef
9.
Adanir T, Erdogan I, Hunerli G, Unveren G, Dasci H, Cetin HY, Ozsan I, Aydin U (2014) The effect of psychological support for the relatives of intensive care unit patients on cadaveric organ donation rate. Transpl Proc 46:3249–3252CrossRef
10.
Campbell ML, Guzman JA (2003) Impact of a proactive approach to improve end-of-life care in a medical ICU. Chest 123:266–271CrossRef
11.
Lilly CM, De Meo DL, Sonna LA, Haley KJ, Massaro AF, Wallace RF, Cody S (2000) An intensive communication intervention for the critically ill. Am J Med 109:469–475CrossRef
12.
Wong DT, Gomez M, McGuire GP, Kavanagh B (1999) Utilization of intensive care unit days in a Canadian medical-surgical intensive care unit. Crit Care Med 27:1319–1324CrossRef
13.
Stricker K, Rothen HU, Takala J (2003) Resource use in the ICU: short- vs. long-term patients. Acta Anaesthesiol Scand 47:508–515CrossRef
14.
Zimmerman JE, Kramer AA, McNair DS, Malila FM, Shaffer VL (2006) Intensive care unit length of stay: benchmarking based on Acute Physiology and Chronic Health Evaluation (APACHE) IV. Crit Care Med 34:2517–2529CrossRef
15.
Bagshaw SM, Opgenorth D, Potestio M, Hastings SE, Hepp SL, Gilfoyle E, McKinlay D, Boucher P, Meier M, Parsons-Leigh J, Gibney RT, Zygun DA, Stelfox HT (2017) Healthcare provider perceptions of causes and consequences of ICU capacity strain in a large publicly funded integrated health region: a qualitative study. Crit Care Med 45:e347–e356CrossRef
16.
Clay AM, Parsh B (2016) Patient- and family-centered care: it’s not just for pediatrics anymore. AMA J Ethics 18:40–44CrossRef
17.
Gruenberg DA, Shelton W, Rose SL, Rutter AE, Socaris S, McGee G (2006) Factors influencing length of stay in the intensive care unit. Am J Critical Care 15:502–509
18.
Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, Barnoud D, Bleichner G, Bruel C, Choukroun G, Curtis JR, Fieux F, Galliot R, Garrouste-Orgeas M, Georges H, Goldgran-Toledano D, Jourdain M, Loubert G, Reignier J, Saidi F, Souweine B, Vincent F, Barnes NK, Pochard F, Schlemmer B, Azoulay E (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356:469–478CrossRef
19.
Hutchison PJ, McLaughlin K, Corbridge T, Michelson KN, Emanuel L, Sporn PH, Crowley-Matoka M (2016) Dimensions and role-specific mediators of surrogate trust in the ICU. Crit Care Med 44:2208–2214CrossRef
20.
Mosenthal AC, Murphy PA, Barker LK, Lavery R, Retano A, Livingston DH (2008) Changing the culture around end-of-life care in the trauma intensive care unit. J Trauma 64:1587–1593CrossRef
21.
Schneiderman LJ, Gilmer T, Teetzel HD, Dugan DO, Blustein J, Cranford R, Briggs KB, Komatsu GI, Goodman-Crews P, Cohn F, Young EW (2003) Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial. JAMA 290:1166–1172CrossRef
22.
Khandelwal N, Kross EK, Engelberg RA, Coe NB, Long AC, Curtis JR (2015) Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review. Crit Care Med 43:1102–1111CrossRef
23.
White DB, Angus DC, Shields AM, Buddadhumaruk P, Pidro C, Paner C, Chaitin E, Chang CH, Pike F, Weissfeld L, Kahn JM, Darby JM, Kowinsky A, Martin S, Arnold RM (2018) A randomized trial of a family-support intervention in intensive care units. N Engl J Med 378:2365–2375CrossRef
24.
Curtis JR, Treece PD, Nielsen EL, Gold J, Ciechanowski PS, Shannon SE, Khandelwal N, Young JP, Engelberg RA (2016) Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. Am J Respir Crit Care Med 193:154–162CrossRef
25.
Carson SS, Cox CE, Wallenstein S, Hanson LC, Danis M, Tulsky JA, Chai E, Nelson JE (2016) Effect of palliative care-led meetings for families of patients with chronic critical illness: a randomized clinical trial. JAMA 316:51–62CrossRef
26.
Garrouste-Orgeas M, Max A, Lerin T, Gregoire C, Ruckly S, Kloeckner M, Brochon S, Pichot E, Simons C, El-Mhadri M, Bruel C, Philippart F, Fournier J, Tiercelet K, Timsit JF, Misset B (2016) Impact of proactive nurse participation in ICU family conferences: a mixed-method study. Crit Care Med 44:1116–1128CrossRef
27.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100CrossRef
28.
Brown SM, Rozenblum R, Aboumatar H, Fagan MB, Milic M, Lee BS, Turner K, Frosch DL (2015) Defining patient and family engagement in the intensive care unit. Am J Respir Crit Care Med 191:358–360CrossRef
29.
McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C (2016) PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol 75:40–46CrossRef
30.
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097CrossRef
31.
32.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed) 343:d5928CrossRef
33.
Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135CrossRef
34.
Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56:455–463CrossRef
35.
36.
Curtis JR, Nielsen EL, Treece PD, Downey L, Dotolo D, Shannon SE, Back AL, Rubenfeld GD, Engelberg RA (2011) Effect of a quality-improvement intervention on end-of-life care in the intensive care unit: a randomized trial. Am J Respir Crit Care Med 183:348–355CrossRef
37.
Oostenbrink JB, Buijs-Van der Woude T, van Agthoven M, Koopmanschap MA, Rutten FF (2003) Unit costs of inpatient hospital days. PharmacoEconomics 21:263–271CrossRef
38.
Hughes M, MacKirdy FN, Norrie J, Grant IS (2001) Outcome of long-stay intensive care patients. Intensive Care Med 27:779–782CrossRef
39.
Aslakson R, Cheng J, Vollenweider D, Galusca D, Smith TJ, Pronovost PJ (2014) Evidence-based palliative care in the intensive care unit: a systematic review of interventions. J Palliat Med 17:219–235CrossRef
40.
Nelson JE, Walker AS, Luhrs CA, Cortez TB, Pronovost PJ (2009) Family meetings made simpler: a toolkit for the intensive care unit. J Crit Care 24:626.e627-614CrossRef
41.
Martins B, Oliveira RA, Cataneo AJM (2017) Palliative care for terminally ill patients in the intensive care unit: systematic review and metaanalysis. Palliat Support Care 15:376–383CrossRef
42.
Long AC, Kross EK, Engelberg RA, Downey L, Nielsen EL, Back AL, Curtis JR (2014) Quality of dying in the ICU: is it worse for patients admitted from the hospital ward compared to those admitted from the emergency department? Intensive Care Med 40:1688–1697CrossRef
43.
Gries CJ, Curtis JR, Wall RJ, Engelberg RA (2008) Family member satisfaction with end-of-life decision making in the ICU. Chest 133:704–712CrossRef
44.
Gerstel E, Engelberg RA, Koepsell T, Curtis JR (2008) Duration of withdrawal of life support in the intensive care unit and association with family satisfaction. Am J Respir Crit Care Med 178:798–804CrossRef
45.
Glavan BJ, Engelberg RA, Downey L, Curtis JR (2008) Using the medical record to evaluate the quality of end-of-life care in the intensive care unit. Crit Care Med 36:1138–1146CrossRef
46.
Lamba S, Murphy P, McVicker S, Harris Smith J, Mosenthal AC (2012) Changing end-of-life care practice for liver transplant service patients: structured palliative care intervention in the surgical intensive care unit. J Pain Symptom Manag 44:508–519CrossRef
Metadata
Title
Intensive care unit length of stay is reduced by protocolized family support intervention: a systematic review and meta-analysis
Authors
Hyun Woo Lee
Yeonkyung Park
Eun Jin Jang
Yeon Joo Lee
Publication date
01-08-2019
Publisher
Springer Berlin Heidelberg
Keyword
Care
Published in
Intensive Care Medicine / Issue 8/2019
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-019-05681-3

Other articles of this Issue 8/2019

Intensive Care Medicine 8/2019 Go to the issue

Imaging in Intensive Care Medicine

A patient with dermo-chondro-corneal dystrophy (François syndrome) and acute dyspnea

Letter

Post-resuscitation EQ-5D-3L scoring by the patient or caregiver/legal guardian versus the medical professional: a sub-study of the Jerusalem District Resuscitation Study

Editorial

Focus on infection

Correspondence

High-flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: author's reply

Correspondence

Prognostic relevance of serum lactate kinetics: a powerful predictor but not Chuck Norris in Intensive Care Medicine

Imaging in Intensive Care Medicine

Traumatic occipitoatlantal dissociation: high index of suspicion should be kept in mind