Effects of a patient/family-centered practice change on the quality and cost of intensive care: research protocol

Authors

  • Laurel E. Radwin,

    1. Laurel E. Radwin PhD RN Nursing Health Services Research Consultant, Adjunct Professor University of Massachusetts Boston, Chelmsford, Massachusetts, USA
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  • Lillian Ananian,

    1. Lillian Ananian MS RN Clinical Nurse Specialist Massachusetts General Hospital, Medical Intensive Care Unit, Boston,Massachusetts, USA
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  • Howard J. Cabral,

    1. Howard J. Cabral MPh PhD Associate Professor Biostatistics, Boston University School of Public Health, Massachusetts, USA
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  • Adele Keeley,

    1. Adele Keeley MA RN Nurse Director Massachusetts General Hospital, Medical Intensive Care Unit, Boston,Massachusetts, USA
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  • Paul F. Currier

    1. Paul F. Currier MD MPh Instructor Department of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA
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L.E. Radwin: e-mail: ler627@gmail.com

Abstract

radwin l.e., ananian l., cabral h.j., keeley a. & currier p.f. (2010) Effects of a patient/family-centered practice change on the quality and cost of intensive care: research protocol. Journal of Advanced Nursing67(1), 215–224.

Abstract

Aim.  This paper is a description of a protocol for studying the impact of a patient/family-centered, evidence-based practice change on the quality, cost and use of services for critically ill patients at the end of life.

Background.  International attention currently is focused on the quality and cost/use of intensive care services. Empirical literature and expert opinion suggest that early, enhanced communication among the clinical team and the patient and family results in higher quality and less costly care at the end of life.

Design.  Our Medical Intensive Care Unit practice change involves three components: teaching sessions for all Registered Nurses and physicians assigned to the unit; patient/family meetings held in 72 hours of the patient’s admission to the unit; and formal documentation to support communication among clinicians. Ethical approval was obtained in April 2009. A two-group post-test design is used, with one group comprising patients hospitalized before the practice change and their families, and the second group of patients/families after the practice change. Data comprise medical record information and families’ responses to surveys. Final analytic models will result from multivariable regression techniques.

Discussion.  The study represents translational research in that interventions are brought to the bedside to reach the people for whom the interventions were designed. The practice change is likely to endure after the study because our research team is composed of both clinicians and scientists. Also, direct care clinicians endorse and are responsible for the practice change.

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