Quality of care and resource use among mechanically ventilated patients before and after an intervention to assist nurse-nonvocal patient communication.
OBJECTIVE
Implement and test unit-wide patient-nurse assisted communication strategies (SPEACS).


BACKGROUND
SPEACS improved nurse-patient communication outcomes; effects on patient care quality and resource use are unknown.


METHODS
Prospective, randomized stepped-wedge pragmatic trial of 1440 adults ventilated ≥2 days and awake for at least one shift in 6 ICUs at 2 teaching hospitals 2009-2011 with blinded retrospective medical record abstraction.


RESULTS
323/383 (84%) nurses completed training; their communication knowledge (p < .001) and satisfaction and comfort (p < .001) increased. ICU days with physical restraint use (p = .44), heavy sedation (p = .73), pain score documentation (p = .97), presence of ICU-acquired pressure ulcers (p = .78), coma-free days (p = .76), ventilator-free days (p = .83), ICU length of stay (p = .77), hospital length of stay (p = .22), and median costs (p = .07) did not change.


CONCLUSIONS
SPEACS improved ICU nurses' knowledge, satisfaction and comfort in communicating with nonvocal MV patients but did not impact patient care quality or resource use.
The Ohio State University College of Nursing, Columbus, OH, USA; The CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA. Electronic address: aeb2@pitt.edu.
Mary Beth
MB
Happ
Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
Susan M
SM
Sereika
Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
Martin P
MP
Houze
The CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
Jennifer B
JB
Seaman
The Ohio State University College of Nursing, Columbus, OH, USA.
Judith A
JA
Tate
Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
Marci L
ML
Nilsen
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Jennifer
J
van Panhuis
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Andrea
A
Scuilli
Brooke M
BM
Baumann
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Brooke
B
Paull
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Elisabeth
E
George
The CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Derek C
DC
Angus
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
Amber E
AE
Barnato
D003142:Communication; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000523:psychology; D011446:Prospective Studies; D011787:Quality of Health Care; D012121:Respiration, Artificial
Augmentative and alternative communications systems; Education; Endotracheal; Intubation; Nurses; Quality of health care