Dr. Douglas White recently received an R01 grant for his project, “Stepped Wedge Trial of an Intervention to Support Proxy Decision Makers in ICUs.” The objective of Dr. White’s project is to conduct a multi-center, randomized stepped wedge trial testing the quality improvement PARTNER intervention in 5 ICUs among 1000 patients with advanced critical illness and their surrogates. The project is scheduled to last from September 19, 2014 until June 30, 2019.
The PARTNER intervention (PAiring Re-engineered ICU Teams with Nurse driven Emotional Support and Relationship-building) was a pilot project implemented as a Quality Improvement Initiative approved by UMPC. The PARTNER intervention was designed to address the deficiencies in communication between clinicians and families, which can cause adverse bereavement outcomes among family members of patients who may receive unwanted end-of-life care that is often of poor quality. Through a variety of measures designed to increase communication between physicians and families and to offer more emotional support and a broader spectrum of care to families of critically-ill patients, the PARTNER initiative documented that intervention is feasible, sustainable, and is associated with shorter ICU lengths of stay and lower hospital costs.
By expanding the PARTNER intervention to be tested in five additional ICUs, this project has the potential to address important public health problems that potentially affect more than 600,000 adults who die annually in ICUs. The intervention is innovative in its theoretical grounding in decision psychology and behavioral economics, the breadth and intensity of support provided to surrogates, the systems-level design of the intervention, and the strategy to use the existing clinical team to deploy the intervention instead of hiring external interventionists.
Douglas B. White, MD, MAS, is the UPMC Endowed Chair for Ethics in Critical Care Medicine, Associate Professor of Critical Care Medicine, and Director of the Program on Ethics and Decision Making in Critical Illness at the University of Pittsburgh Medical Center.