• Patricia C Dykes, Ronen Rozenblum, Anuj Dalal, Anthony Massaro, Frank Chang, Marsha Clements, Sarah Collins, Jacques Donze, Maureen Fagan, Priscilla Gazarian, John Hanna, Lisa Lehmann, Kathleen Leone, Stuart Lipsitz, Kelly McNally, Conny Morrison, Lipika Samal, Eli Mlaver, Kumiko Schnock, Diana Stade, Deborah Williams, Catherine Yoon, and David W Bates.
• 1Center for Patient Safety, Research and Practice, Brigham and Women's Hospital, Boston, MA.2Harvard Medical School, Boston, MA.
• Crit. Care Med. 2017 Aug 1; 45 (8): e806-e813.

ObjectivesStudies comprehensively assessing interventions to improve team communication and to engage patients and care partners in ICUs are lacking. This study examines the effectiveness of a patient-centered care and engagement program in the medical ICU.DesignProspective intervention study.SettingMedical ICUs at large tertiary care center.PatientsTwo thousand one hundred five patient admissions (1,030 before and 1,075 during the intervention) from July 2013 to May 2014 and July 2014 to May 2015.InterventionsStructured patient-centered care and engagement training program and web-based technology including ICU safety checklist, tools to develop shared care plan, and messaging platform. Patient and care partner access to online portal to view health information, participate in the care plan, and communicate with providers.Measurements And Main ResultsPrimary outcome was aggregate adverse event rate. Secondary outcomes included patient and care partner satisfaction, care plan concordance, and resource utilization. We included 2,105 patient admissions, (1,030 baseline and 1,075 during intervention periods). The aggregate rate of adverse events fell 29%, from 59.0 per 1,000 patient days (95% CI, 51.8-67.2) to 41.9 per 1,000 patient days (95% CI, 36.3-48.3; p < 0.001), during the intervention period. Satisfaction improved markedly from an overall hospital rating of 71.8 (95% CI, 61.1-82.6) to 93.3 (95% CI, 88.2-98.4; p < 0.001) for patients and from 84.3 (95% CI, 81.3-87.3) to 90.0 (95% CI, 88.1-91.9; p < 0.001) for care partners. No change in care plan concordance or resource utilization.ConclusionsImplementation of a structured team communication and patient engagement program in the ICU was associated with a reduction in adverse events and improved patient and care partner satisfaction.

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