Secondary Logo

Institutional members access full text with Ovid®

Prospective Evaluation of a Multifaceted Intervention to Improve Outcomes in Intensive Care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study*

Dykes, Patricia C. PhD, RN1,2; Rozenblum, Ronen PhD1,2; Dalal, Anuj MD1,2; Massaro, Anthony MD1,2; Chang, Frank MSE1; Clements, Marsha MSN, RN1; Collins, Sarah PhD, RN1,2; Donze, Jacques MD1; Fagan, Maureen DNP, RN1; Gazarian, Priscilla PhD, RN1; Hanna, John BS1; Lehmann, Lisa MD1,2; Leone, Kathleen MBA, RN1; Lipsitz, Stuart ScD1,2; McNally, Kelly BS1; Morrison, Conny BA1; Samal, Lipika MD, MSc1,2; Mlaver, Eli BA1; Schnock, Kumiko PhD1,2; Stade, Diana BA1; Williams, Deborah BA1; Yoon, Catherine MPH1; Bates, David W. MD, MSc1,2

doi: 10.1097/CCM.0000000000002449
Online Clinical Investigations
Buy
SDC

Objectives: Studies comprehensively assessing interventions to improve team communication and to engage patients and care partners in ICUs are lacking. This study examines the effectiveness of a patient-centered care and engagement program in the medical ICU.

Design: Prospective intervention study.

Setting: Medical ICUs at large tertiary care center.

Patients: Two thousand one hundred five patient admissions (1,030 before and 1,075 during the intervention) from July 2013 to May 2014 and July 2014 to May 2015.

Interventions: Structured patient-centered care and engagement training program and web-based technology including ICU safety checklist, tools to develop shared care plan, and messaging platform. Patient and care partner access to online portal to view health information, participate in the care plan, and communicate with providers.

Measurements and Main Results: Primary outcome was aggregate adverse event rate. Secondary outcomes included patient and care partner satisfaction, care plan concordance, and resource utilization. We included 2,105 patient admissions, (1,030 baseline and 1,075 during intervention periods). The aggregate rate of adverse events fell 29%, from 59.0 per 1,000 patient days (95% CI, 51.8–67.2) to 41.9 per 1,000 patient days (95% CI, 36.3–48.3; p < 0.001), during the intervention period. Satisfaction improved markedly from an overall hospital rating of 71.8 (95% CI, 61.1–82.6) to 93.3 (95% CI, 88.2–98.4; p < 0.001) for patients and from 84.3 (95% CI, 81.3–87.3) to 90.0 (95% CI, 88.1–91.9; p < 0.001) for care partners. No change in care plan concordance or resource utilization.

Conclusions: Implementation of a structured team communication and patient engagement program in the ICU was associated with a reduction in adverse events and improved patient and care partner satisfaction.

Supplemental Digital Content is available in the text.

1Center for Patient Safety, Research and Practice, Brigham and Women’s Hospital, Boston, MA.

2Harvard Medical School, Boston, MA.

*See also p. 1424.

Registration: ClinicalTrials.gov, number NCT02258594.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by The Gordon and Betty Moore Foundation.

Dr. Dykes’s institution received funding from the Gordon and Betty Moore Foundation (GBMF). Dr. Rozenblum’s institution received funding from the GBMF; he disclosed that he is a cofounder of Hospitech Respiration; and he disclosed work for hire. Dr. Dalal’s institution received funding from the GBMF. Dr. Massaro’s institution received funding from the GBMF and from Risk Management Foundation Insurance Company. Dr. Chang received support for article research from the National Institutes of Health. Dr. Clements’ institution received funding from the GBMF. Dr. Collins’ institution received funding from the GBMF, from research grants funded by Agency for Healthcare Research & Quality, and research contracts funded by the Food and Drug Administration and ASPR. Dr. Donze’s institution received funding from the GBMF, and he received funding from Swiss National Science Foundation. Dr. Gazarian’s institution received funding from the GBMF. Dr. Hanna disclosed work for hire. Dr. Lehmann’s institution received funding from the GBMF. Dr. Morrison’s institution received funding from the GBMF. Dr. Samal’s institution received funding from the GBMF. Dr. Schnock’s institution received funding from the GBMF, and she received support for article research from the GBMF. Dr. Bates’ institution received funding from the GBMF; he received funding from SEA Medical, Intensix, EarlySense, QPID, Zynx, CDI (Negev), Enelgy, ValeraHealth, and MDClone; and he disclosed that he is a coinventor on Patent No. 6029138 held by Brigham and Women’s Hospital on the use of decision support software for medical management, licensed to the Medicalis Corporation, where he holds a minority equity position. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Patricia C. Dykes, PhD, RN, Center for Patient Safety, Research and Practice, Brigham and Women’s Hospital, 1620 Tremont St., Boston, MA. E-mail: pdykes@bwh.harvard.edu

Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.