Skip to main content

Advertisement

SpringerLink
Log in

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

  • Systematic Review
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

A Correction to this article was published on 08 October 2019

This article has been updated

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

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.

References

  1. Kynoch K, Chang A, Coyer F, McArdle A (2016) The effectiveness of interventions to meet family needs of critically ill patients in an adult intensive care unit: a systematic review update. JBI Database Syst Rev Implement Rep 14:181–234

    Article  Google Scholar 

  2. Goldfarb MJ, Bibas L, Bartlett V, Jones H, Khan N (2017) Outcomes of patient- and family-centered care interventions in the ICU: a systematic review and meta-analysis. Crit Care Med 45:1751–1761

    Article  Google Scholar 

  3. Kyeremanteng K, Gagnon LP, Thavorn K, Heyland D, D’Egidio G (2018) The impact of palliative care consultation in the ICU on length of stay: a systematic review and cost evaluation. J Intensive Care Med 33:346–353

    Article  Google Scholar 

  4. Wendler D, Rid A (2011) Systematic review: the effect on surrogates of making treatment decisions for others. Ann Intern Med 154:336–346

    Article  Google Scholar 

  5. Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, Annane D, Bleichner G, Bollaert PE, Darmon M, Fassier T, Galliot R, Garrouste-Orgeas M, Goulenok C, Goldgran-Toledano D, Hayon J, Jourdain M, Kaidomar M, Laplace C, Larche J, Liotier J, Papazian L, Poisson C, Reignier J, Saidi F, Schlemmer B (2005) Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 171:987–994

    Article  Google Scholar 

  6. Gries CJ, Engelberg RA, Kross EK, Zatzick D, Nielsen EL, Downey L, Curtis JR (2010) Predictors of symptoms of posttraumatic stress and depression in family members after patient death in the ICU. Chest 137:280–287

    Article  Google Scholar 

  7. Kon AA, Davidson JE, Morrison W, Danis M, White DB (2016) Shared decision making in ICUs: an American College of critical care medicine and american thoracic society policy statement. Crit Care Med 44:188–201

    Article  Google Scholar 

  8. Davidson JE, Aslakson RA, Long AC, Puntillo KA, Kross EK, Hart J, Cox CE, Wunsch H, Wickline MA, Nunnally ME, Netzer G, Kentish-Barnes N, Sprung CL, Hartog CS, Coombs M, Gerritsen RT, Hopkins RO, Franck LS, Skrobik Y, Kon AA, Scruth EA, Harvey MA, Lewis-Newby M, White DB, Swoboda SM, Cooke CR, Levy MM, Azoulay E, Curtis JR (2017) Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med 45:103–128

    Article  Google Scholar 

  9. Adanir T, Erdogan I, Hunerli G, Unveren G, Dasci H, Cetin HY, Ozsan I, Aydin U (2014) The effect of psychological support for the relatives of intensive care unit patients on cadaveric organ donation rate. Transpl Proc 46:3249–3252

    Article  CAS  Google Scholar 

  10. Campbell ML, Guzman JA (2003) Impact of a proactive approach to improve end-of-life care in a medical ICU. Chest 123:266–271

    Article  Google Scholar 

  11. Lilly CM, De Meo DL, Sonna LA, Haley KJ, Massaro AF, Wallace RF, Cody S (2000) An intensive communication intervention for the critically ill. Am J Med 109:469–475

    Article  CAS  Google Scholar 

  12. Wong DT, Gomez M, McGuire GP, Kavanagh B (1999) Utilization of intensive care unit days in a Canadian medical-surgical intensive care unit. Crit Care Med 27:1319–1324

    Article  CAS  Google Scholar 

  13. Stricker K, Rothen HU, Takala J (2003) Resource use in the ICU: short- vs. long-term patients. Acta Anaesthesiol Scand 47:508–515

    Article  CAS  Google Scholar 

  14. Zimmerman JE, Kramer AA, McNair DS, Malila FM, Shaffer VL (2006) Intensive care unit length of stay: benchmarking based on Acute Physiology and Chronic Health Evaluation (APACHE) IV. Crit Care Med 34:2517–2529

    Article  Google Scholar 

  15. Bagshaw SM, Opgenorth D, Potestio M, Hastings SE, Hepp SL, Gilfoyle E, McKinlay D, Boucher P, Meier M, Parsons-Leigh J, Gibney RT, Zygun DA, Stelfox HT (2017) Healthcare provider perceptions of causes and consequences of ICU capacity strain in a large publicly funded integrated health region: a qualitative study. Crit Care Med 45:e347–e356

    Article  Google Scholar 

  16. Clay AM, Parsh B (2016) Patient- and family-centered care: it’s not just for pediatrics anymore. AMA J Ethics 18:40–44

    Article  Google Scholar 

  17. Gruenberg DA, Shelton W, Rose SL, Rutter AE, Socaris S, McGee G (2006) Factors influencing length of stay in the intensive care unit. Am J Critical Care 15:502–509

    Google Scholar 

  18. Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, Barnoud D, Bleichner G, Bruel C, Choukroun G, Curtis JR, Fieux F, Galliot R, Garrouste-Orgeas M, Georges H, Goldgran-Toledano D, Jourdain M, Loubert G, Reignier J, Saidi F, Souweine B, Vincent F, Barnes NK, Pochard F, Schlemmer B, Azoulay E (2007) A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 356:469–478

    Article  CAS  Google Scholar 

  19. Hutchison PJ, McLaughlin K, Corbridge T, Michelson KN, Emanuel L, Sporn PH, Crowley-Matoka M (2016) Dimensions and role-specific mediators of surrogate trust in the ICU. Crit Care Med 44:2208–2214

    Article  Google Scholar 

  20. Mosenthal AC, Murphy PA, Barker LK, Lavery R, Retano A, Livingston DH (2008) Changing the culture around end-of-life care in the trauma intensive care unit. J Trauma 64:1587–1593

    Article  Google Scholar 

  21. Schneiderman LJ, Gilmer T, Teetzel HD, Dugan DO, Blustein J, Cranford R, Briggs KB, Komatsu GI, Goodman-Crews P, Cohn F, Young EW (2003) Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: a randomized controlled trial. JAMA 290:1166–1172

    Article  CAS  Google Scholar 

  22. Khandelwal N, Kross EK, Engelberg RA, Coe NB, Long AC, Curtis JR (2015) Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review. Crit Care Med 43:1102–1111

    Article  Google Scholar 

  23. White DB, Angus DC, Shields AM, Buddadhumaruk P, Pidro C, Paner C, Chaitin E, Chang CH, Pike F, Weissfeld L, Kahn JM, Darby JM, Kowinsky A, Martin S, Arnold RM (2018) A randomized trial of a family-support intervention in intensive care units. N Engl J Med 378:2365–2375

    Article  Google Scholar 

  24. Curtis JR, Treece PD, Nielsen EL, Gold J, Ciechanowski PS, Shannon SE, Khandelwal N, Young JP, Engelberg RA (2016) Randomized trial of communication facilitators to reduce family distress and intensity of end-of-life care. Am J Respir Crit Care Med 193:154–162

    Article  Google Scholar 

  25. Carson SS, Cox CE, Wallenstein S, Hanson LC, Danis M, Tulsky JA, Chai E, Nelson JE (2016) Effect of palliative care-led meetings for families of patients with chronic critical illness: a randomized clinical trial. JAMA 316:51–62

    Article  CAS  Google Scholar 

  26. Garrouste-Orgeas M, Max A, Lerin T, Gregoire C, Ruckly S, Kloeckner M, Brochon S, Pichot E, Simons C, El-Mhadri M, Bruel C, Philippart F, Fournier J, Tiercelet K, Timsit JF, Misset B (2016) Impact of proactive nurse participation in ICU family conferences: a mixed-method study. Crit Care Med 44:1116–1128

    Article  Google Scholar 

  27. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100

    Article  Google Scholar 

  28. Brown SM, Rozenblum R, Aboumatar H, Fagan MB, Milic M, Lee BS, Turner K, Frosch DL (2015) Defining patient and family engagement in the intensive care unit. Am J Respir Crit Care Med 191:358–360

    Article  Google Scholar 

  29. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C (2016) PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol 75:40–46

    Article  Google Scholar 

  30. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097

    Article  Google Scholar 

  31. Higgins JP, Green S (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The cochrane collaboration. Available at https://handbook-5-1.cochrane.org/. Accessed 30 June 2019

  32. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed) 343:d5928

    Article  Google Scholar 

  33. Wan X, Wang W, Liu J, Tong T (2014) Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 14:135

    Article  Google Scholar 

  34. Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56:455–463

    Article  CAS  Google Scholar 

  35. Viechtbauer WJJoss (2010) Conducting meta-analyses in R with the metafor package. Available at https://www.jstatsoft.org/article/view/v036i03. Accessed 30 June 2019

  36. Curtis JR, Nielsen EL, Treece PD, Downey L, Dotolo D, Shannon SE, Back AL, Rubenfeld GD, Engelberg RA (2011) Effect of a quality-improvement intervention on end-of-life care in the intensive care unit: a randomized trial. Am J Respir Crit Care Med 183:348–355

    Article  Google Scholar 

  37. Oostenbrink JB, Buijs-Van der Woude T, van Agthoven M, Koopmanschap MA, Rutten FF (2003) Unit costs of inpatient hospital days. PharmacoEconomics 21:263–271

    Article  Google Scholar 

  38. Hughes M, MacKirdy FN, Norrie J, Grant IS (2001) Outcome of long-stay intensive care patients. Intensive Care Med 27:779–782

    Article  CAS  Google Scholar 

  39. Aslakson R, Cheng J, Vollenweider D, Galusca D, Smith TJ, Pronovost PJ (2014) Evidence-based palliative care in the intensive care unit: a systematic review of interventions. J Palliat Med 17:219–235

    Article  Google Scholar 

  40. Nelson JE, Walker AS, Luhrs CA, Cortez TB, Pronovost PJ (2009) Family meetings made simpler: a toolkit for the intensive care unit. J Crit Care 24:626.e627-614

    Article  Google Scholar 

  41. Martins B, Oliveira RA, Cataneo AJM (2017) Palliative care for terminally ill patients in the intensive care unit: systematic review and metaanalysis. Palliat Support Care 15:376–383

    Article  Google Scholar 

  42. Long AC, Kross EK, Engelberg RA, Downey L, Nielsen EL, Back AL, Curtis JR (2014) Quality of dying in the ICU: is it worse for patients admitted from the hospital ward compared to those admitted from the emergency department? Intensive Care Med 40:1688–1697

    Article  Google Scholar 

  43. Gries CJ, Curtis JR, Wall RJ, Engelberg RA (2008) Family member satisfaction with end-of-life decision making in the ICU. Chest 133:704–712

    Article  Google Scholar 

  44. Gerstel E, Engelberg RA, Koepsell T, Curtis JR (2008) Duration of withdrawal of life support in the intensive care unit and association with family satisfaction. Am J Respir Crit Care Med 178:798–804

    Article  Google Scholar 

  45. Glavan BJ, Engelberg RA, Downey L, Curtis JR (2008) Using the medical record to evaluate the quality of end-of-life care in the intensive care unit. Crit Care Med 36:1138–1146

    Article  Google Scholar 

  46. Lamba S, Murphy P, McVicker S, Harris Smith J, Mosenthal AC (2012) Changing end-of-life care practice for liver transplant service patients: structured palliative care intervention in the surgical intensive care unit. J Pain Symptom Manag 44:508–519

    Article  Google Scholar 

Download references

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.

Author information

Author notes

  1. Hyun Woo Lee and Yeonkyung Park are co-first authors.

Authors and Affiliations

  1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea

    Hyun Woo Lee

  2. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Portland, USA

    Yeonkyung Park

  3. Department of Information Statistics, Andong National University, Andong, South Korea

    Eun Jin Jang

  4. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, 13620, South Korea

    Yeon Joo Lee

Authors
  1. Hyun Woo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yeonkyung Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eun Jin Jang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yeon Joo Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Corresponding author

Correspondence to Yeon Joo Lee.

Ethics declarations

Conflicts of interest

The authors have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 20 kb)

Supplementary material 2 (DOCX 34 kb)

Supplementary material 3 (DOCX 38 kb)

134_2019_5681_MOESM4_ESM.tiff

Supplementary appendix 4. Forest plot of subgroup analysis for the intensive care unit length of stay by therapeutic goal (TIFF 1154 kb)

134_2019_5681_MOESM5_ESM.tiff

Supplementary appendix 5. Forest plot of subgroup analysis for the intensive care unit length of stay by method of measurement (TIFF 1160 kb)

134_2019_5681_MOESM6_ESM.tiff

Supplementary appendix 6. Forest plot of subgroup analysis for the intensive care unit length of stay by timing of intervention (TIFF 1205 kb)

Supplementary appendix 7. Forest plot for mortality in the intensive care unit (TIFF 718 kb)

Supplementary appendix 8. Forest plot for mortality in the hospital (TIFF 798 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-019-05681-3

Keywords

Search

Navigation