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

  • Hyun Woo Lee
  • Yeonkyung Park
  • Eun Jin Jang
  • Yeon Joo LeeEmail author
Systematic Review



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.


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.


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.


Protocolized family support intervention for enhanced communication and shared decision-making with the family reduced ICU LOS in critically ill patients without impacting mortality.


Intensive care units Critical care Professional-family relations Decision-making Decision support techniques 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

Study concept and design: HWL and YJL. Data acquisition: HWL and YKP. Data analysis and interpretation: HWL and EJJ. Drafting of the manuscript: HWL. Critical revision of the manuscript and important intellectual content: HWL and YJL. Study supervision: YJL.


The authors declare that they have taken no support from any organization for the submitted work. The authors also have no conflicts of interest to declare.

Compliance with ethical standards

Conflicts of interest

The authors have no conflicts of interest to declare.

Supplementary material

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Supplementary material 1 (DOCX 20 kb)
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Supplementary material 2 (DOCX 34 kb)
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Supplementary material 3 (DOCX 38 kb)
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Supplementary appendix 4. Forest plot of subgroup analysis for the intensive care unit length of stay by therapeutic goal (TIFF 1154 kb)
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Supplementary appendix 5. Forest plot of subgroup analysis for the intensive care unit length of stay by method of measurement (TIFF 1160 kb)
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Supplementary appendix 6. Forest plot of subgroup analysis for the intensive care unit length of stay by timing of intervention (TIFF 1205 kb)
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Supplementary appendix 7. Forest plot for mortality in the intensive care unit (TIFF 718 kb)
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Supplementary appendix 8. Forest plot for mortality in the hospital (TIFF 798 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of MedicineSeoul National University HospitalSeoulSouth Korea
  2. 2.Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineVeterans Health Service Medical CenterPortlandUSA
  3. 3.Department of Information StatisticsAndong National UniversityAndongSouth Korea
  4. 4.Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of MedicineSeoul National University Bundang Hospital 82Bundang-guSouth Korea

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