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

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.

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Availability of data and material

The data sets used and/or analyzed can be obtained from the corresponding author on reasonable request.

Change history

  • 08 October 2019

    The original version of this article unfortunately contained a mistake. One of the affiliations was incorrect: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Portland, USA.

  • 08 October 2019

    The original version of this article unfortunately contained a mistake. One of the affiliations was incorrect: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Portland, USA.

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Acknowledgements

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

Funding

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.

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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.

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Correspondence to Yeon Joo Lee.

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Lee, H.W., Park, Y., Jang, E.J. et al. Intensive care unit length of stay is reduced by protocolized family support intervention: a systematic review and meta-analysis. Intensive Care Med 45, 1072–1081 (2019). https://doi.org/10.1007/s00134-019-05681-3

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Keywords

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