title: Improving family communications at the end of life: implications for length of stay in the intensive care unit and resource use.
abstract: BACKGROUND
  Inadequate communication persists between healthcare professionals and patients and patients' families in intensive care units. Unwanted or ineffective treatments can occur when patients' goals of care are unknown or not honored, increasing costs and care. Having the primary physician provide medical information and then having a physician and clinical nurse specialist team improve opportunities for patients and their families to process that information could improve the situation. This model has not been tested for its effect on patients' outcomes and resource utilization.
  
  
  OBJECTIVE
  To evaluate the effect of a communication team that included a physician and a clinical nurse specialist on length of stay and costs for patients near the end of life in the intensive care unit.
  
  
  METHODS
  During a 1-year period, patients judged to be at high risk for death (N = 151) were divided into 2 groups: 43 patients who were cared for by the medical director teamed with a clinical nurse specialist and 108 patients who received standard care, provided by an attending physician.
  
  
  RESULTS
  Compared with the control group, patients in the intervention group had significantly shorter stays in both the intensive care unit (6.1 vs 9.5 days) and the hospital (11.3 vs 16.4 days) and had lower fixed ($15,559 vs $24,080) and variable ($5087 vs $8035) costs.
  
  
  CONCLUSIONS
  Use of a physician and a clinical nurse specialist focused on improving communication with patients and patients' families reduced lengths of stay and resource utilization.
authors.affiliation: Barnes-Jewish Hospital, St. Louis, Mo., USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Ahrens
authors.forename: Valerie
authors.initials: V
authors.lastname: Yancey
authors.forename: Marin
authors.initials: M
authors.lastname: Kollef
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003142:Communication; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010347:Patient Care Planning; D010348:Patient Care Team; D011368:Professional-Family Relations; D013727:Terminal Care / Q000379:methods*