Quality improvement (QI) interventions to improve communication with very sick patients are effective at reducing length of stay in the ICU and the use of nonbeneficial aggressive treatment, a review found.
Researchers used several data sources, such as MEDLINE and Cochrane, to systematically review 20 studies on QI interventions aimed at improving communication with patients with life-limiting or severe life-threatening illness and/or their families. They also sought to determine whether a consultative or integrative intervention approach worked best. The former involves consulting with communication specialists such as palliative medicine teams, while the latter involves embedding palliative care principles and intervention into the practice of the usual care team. Researchers included only prospective, controlled studies published between January 2000 and December 2011 in their analysis.
Thirteen (65%) of the studies took place in the intensive care unit (ICU). The four main intervention types, and their associated rates of improvement in health care utilization (like lower ICU stay length), were:
- family meetings with the usual team (11 studies, 77% of which saw improvement in utilization),
- palliative care teams (5 studies, 50% saw improvement),
- ethics consultation (2 studies, 100% saw improvement) and
- physician-patient communication (2 studies, no improvement).
Among those studies that addressed health care utilization, such as ICU length of stay and potentially nonbeneficial life-sustaining aggressive treatment, 73% found statistically significant improvement. In studies that evaluated intervention impact on quality of life, symptom control and satisfaction, most findings weren't significant. A higher proportion of consultative studies found statistically significant improvement related to the intervention than did integrative studies. Results were published online Oct. 26 by the Journal of General Internal Medicine.
“Our study supports that consultative interventions, as opposed to integrative ones, are more likely to potentially improve healthcare utilization, although there are successful examples of both interventions types,” the authors wrote. This may be, in part, because consultative teams can focus more on communication without the need to balance clinical duties, they noted.