Economic Feasibility of Staffing the Intensive Care Unit with a Communication Facilitator.
In the intensive care unit (ICU), complex decision making by clinicians and families requires good communication to ensure that care is consistent with the patients' values and goals.



To assess the economic feasibility of staffing ICUs with a communication facilitator.



Data were from a randomized trial of an "ICU communication facilitator" linked to hospital financial records; eligible patients (n = 135) were admitted to the ICU at a single hospital with predicted mortality ≥30% and a surrogate decision maker. Adjusted regression analyses assessed differences in ICU total and direct variable costs between intervention and control patients. A bootstrap-based simulation assessed the cost efficiency of a facilitator while varying the full-time equivalent of the facilitator and the ICU mortality risk.



Total ICU costs (mean 22.8k; 95% CI, -42.0k to -3.6k; P = 0.02) and average daily ICU costs (mean, -0.38k; 95% CI, -0.65k to -0.11k; P = 0.006)] were reduced significantly with the intervention. Despite more contacts, families of survivors spent less time per encounter with facilitators than did families of decedents (mean, 25 [SD, 11] min vs. 36 [SD, 14] min). Simulation demonstrated maximal weekly savings with a 1.0 full-time equivalent facilitator and a predicted ICU mortality of 15% (total weekly ICU cost savings, $58.4k [95% CI, $57.7k-59.2k]; weekly direct variable savings, $5.7k [95% CI, $5.5k-5.8k]) after incorporating facilitator costs.



Adding a full-time trained communication facilitator in the ICU may improve the quality of care while simultaneously reducing short-term (direct variable) and long-term (total) health care costs. This intervention is likely to be more cost effective in a lower-mortality population.
1 Department of Anesthesiology and Pain Medicine, and.
Nita
N
Khandelwal
2 Department of Biostatistics, University of California-Berkeley, Berkeley, California.
David
D
Benkeser
3 Department of Health Services, University of Washington, Seattle, Washington; and.
Norma B
NB
Coe
4 Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, and.
Ruth A
RA
Engelberg
4 Cambia Palliative Care Center of Excellence and Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, and.
J Randall
JR
Curtis
D000328:Adult; D000368:Aged; D003142:Communication; D017046:Cost Savings / Q000706:statistics & numerical data*; D003422:Critical Care / Q000191:economics; D016208:Databases, Factual; D003657:Decision Making; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics; D012044:Regression Analysis; D014861:Washington; D000078329:Workforce
communication; critical care; intensive care unit costs; palliative care
Crit Care Med. 2004 Sep;32(9):1839-43
15343010
JAMA. 2003 Sep 3;290(9):1166-72
12952998
BMC Health Serv Res. 2011 Nov 24;11:319
22111656
Chest. 2011 Mar;139(3):543-54
21106660
Intensive Care Med. 2002 Nov;28(11):1619-24
12415450
Am J Respir Crit Care Med. 2011 Feb 1;183(3):348-55
20833820
Crit Care Med. 2000 Dec;28(12):3920-4
11153636
Crit Care Med. 2001 Feb;29(2 Suppl):N26-33
11228570
Am J Med. 2000 Oct 15;109(6):469-75
11042236
N Engl J Med. 2007 Feb 1;356(5):469-78
17267907
Ann Intern Med. 1982 Jan;96(1):102-9
7053682
J Palliat Med. 2010 Aug;13(8):973-9
20642361
Intensive Care Med. 2005 Feb;31(2):243-9
15668764
Arch Intern Med. 2008 Sep 8;168(16):1783-90
18779466
Crit Care Med. 2003 May;31(5 Suppl):S394-9
12771590
Am J Respir Crit Care Med. 2016 Jan 15;193(2):154-62
26378963
Health Aff (Millwood). 2011 Mar;30(3):454-63
21383364
Am J Respir Crit Care Med. 2002 Feb 15;165(4):438-42
11850333
J Trauma. 2008 Jun;64(6):1587-93
18545128
J Nurs Manag. 2013 Sep;21(6):860-6
23924377
J Palliat Med. 2006 Aug;9(4):855-60
16910799
Crit Care Med. 2015 May;43(5):1102-11
25574794
Am J Respir Crit Care Med. 2008 Aug 1;178(3):269-75
18480429