Improving ICU care and communication through technology use

July 17, 2017, Brigham and Women's Hospital

Hospitalization in an intensive care unit (ICU) can be a frightening and sometimes traumatizing experience for patients. Although engaging the patient and improving communication among the clinical team can positively impact care and the patient experience, the ICU environment can be a challenging place to engage patients. In new research, led by Brigham and Women's Hospital, researchers tested a structured and technology-centered program that was focused on team communication and patient engagement. They found that this approach was associated with a lower rate of adverse events and improved patient satisfaction. Results of this project, named PROSPECT (Promoting Respect and Ongoing Safety through Patient Engagement Communication and Technology), are published in August issue of Critical Care Medicine.

"Our goal was to shift our clinical thinking from 'What is the matter?' to discovering 'What matters to you?'" said Patricia Dykes, PhD, RN, a senior nurse scientist in the Center for Patient Safety, Research and Practice at BWH and lead author of the paper. "If we can effectively collaborate with our and their care partners and engage them in their care, then we have the potential to enhance the care, improve adherence to care plans, positively impact satisfaction rates and reduce healthcare costs."

Researchers developed an intervention to support integrated, multidisciplinary patient-centered communication characterized by shared checklists, health information, and goals of care articulated by both clinicians and patients. The aim of the intervention, which was tested in two medical ICUs at BWH and included 1,075 patients and their care partners, was to reduce defined as falls, pressure ulcers, catheter-associated urinary tract infections and ventilator-associated events. Secondarily, the team also sought to improve patient and care partners' satisfaction rates, agreement on care plans between patient and providers, and healthcare utilization.

The specific interventions were systems-based and included a 60-min training session for all clinicians involved in the study. The training introduced a standard model for care meant to enhance clinicians' responsiveness to the needs, concerns and expectations of the patients and their care partners as well as training on a web-based toolkit to facilitate team communication and . The web-based toolkit included an ICU safety checklist that populated with real-time data from the patient's electronic health record (EHR). The toolkit also included shared care planning and messaging tools accessed by clinicians through the EHR and by patients and care partners through a bedside portal on an iPad. Eighteen percent of patients and care partners used the portal to document their goals of care, their preferences, and to directly communicate.

When compared to a similar group of ICU patients, researchers found that the intervention was associated with a 29 percent reduction in adverse events. The reduction was determined by the drop in adverse events per 1,000 patient days. Patient days are the total number of days for all patients who were admitted for an episode of care, for example, 20 patients in a hospital for 1 day would represent 20 patient days. The rate fell from 59 per 1,000 patient days in the baseline period to 41.9 per 1,000 patient days in the intervention period, driven by a drop in the number of catheter-associated and pressure ulcers. While researchers are unable to determine which specific component of the intervention drove this reduction, they suspect it is due largely to implementation of the electronic check list, as only a small percentage of patients or care partners participated through the portal.

"We took the paper checklist that is widely used in ICUs across the country and enhanced it with technology. This allowed more patient-specific information to be available to the multidisciplinary group of clinicians that were making daily decisions about a patient's care while they executed the checklist," said Dykes. "For example, if you're deciding whether or not to remove a catheter or a central line, it is extremely helpful to know the type of catheter and when it was put in. When using a paper check list, that information is not available, but if you transition that checklist to a web-based tool that pulls data from a patient's electronic health record, then you can make a much more informed decision."

Researchers also found an improvement in patient satisfaction scores, which were captured through a survey of a subsample of patients and care partners. Ninety-three percent of patients in the intervention who responded to the survey assigned a top score to their overall hospital rating score compared to 71.8 percent of patients in the baseline group. Care partner satisfaction also improved, from 84.3 to 90 percent. Changes in concordance of the care plan between the care team and patients was not observed and resource utilization did not significantly change between the intervention and baseline groups.

"Daily use of the web-based safety checklist enables review of the critical care safety elements; patient goals, preferences, and priorities were systematically addressed. This review translated into routinely focusing on patients' concerns, updating the care plan and reviewing adherence with standard critical care safety elements," the authors write.

Explore further: Hospital discharge program improves patient experience leaving the hospital

More information: Patricia C. Dykes et al, Prospective Evaluation of a Multifaceted Intervention to Improve Outcomes in Intensive Care, Critical Care Medicine (2017). DOI: 10.1097/CCM.0000000000002449

Related Stories

Hospital discharge program improves patient experience leaving the hospital

July 6, 2017
A standardized, in-hospital discharge planning program, known as Project ReEngineered Dishcharge (RED), improves patient experience as they leave the hospital, according to researchers at Boston Medical Center. The study, ...

Radiologists seek greater involvement in patient care

June 20, 2017
Despite constraints of time and workload, radiologists are looking for ways to become more directly involved in the care of their patients, according to the findings of a recent survey of radiologists, published online in ...

Use of mobile app reduces number of in-person follow-up visits after surgery

March 22, 2017
Patients who underwent ambulatory breast reconstruction and used a mobile app for follow-up care had fewer in-person visits during the first 30 days after the operation without affecting complication rates or measures of ...

Researchers find a web-based patient-centered toolkit helps improve patient-provider communication

August 7, 2015
Health care organizations have been implementing health information technology at increasing rates in an effort to engage patients and caregivers improve patient satisfaction, and favorably impact outcomes. A new study led ...

Study shows one of the deadliest hospital-acquired infections is preventable

May 22, 2017
For some hospital patients, going on a ventilator is often the difference between life and death. About 800,000 hospital patients undergo mechanical ventilation each year in the United States due to a variety of illnesses ...

Patient satisfaction high with nurse-led chronic kidney Dz care

February 8, 2017
(HealthDay)—For patients with chronic kidney disease (CKD), patient satisfaction is high with care at nurse-led clinics, according to a study published online Feb. 3 in the Journal of Renal Care.

Recommended for you

Sweet, bitter, fat: New study reveals impact of genetics on how kids snack

February 22, 2018
Whether your child asks for crackers, cookies or veggies to snack on could be linked to genetics, according to new findings from the Guelph Family Health Study at the University of Guelph.

The good and bad health news about your exercise posts on social media

February 22, 2018
We all have that Facebook friend—or 10—who regularly posts photos of his or her fitness pursuits: on the elliptical at the gym, hiking through the wilderness, crossing a 10K finish line.

Smartphones are bad for some teens, not all

February 21, 2018
Is the next generation better or worse off because of smartphones? The answer is complex and research shows it largely depends on their lives offline.

Tackling health problems in the young is crucial for their children's future

February 21, 2018
A child's growth and development is affected by the health and lifestyles of their parents before pregnancy - even going back to adolescence - according to a new study by researchers at the Murdoch Children's Research Institute, ...

Lead and other toxic metals found in e-cigarette 'vapors': study

February 21, 2018
Significant amounts of toxic metals, including lead, leak from some e-cigarette heating coils and are present in the aerosols inhaled by users, according to a study from scientists at Johns Hopkins Bloomberg School of Public ...

Why teens need up to 10 hours' sleep

February 21, 2018
Technology, other distractions and staying up late make is difficult, but researchers say teenagers need to make time for 8-10 hours of sleep a night to optimise their performance and maintain good health and wellbeing.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.