ICU Communication Tool for Serious Injury

Recruiting in Palo Alto (17 mi)

+7 other locations

Overseen byMargaret L Schwarze, MD, MPP

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: University of Wisconsin, Madison

No Placebo Group

Trial Summary

What is the purpose of this trial?The purpose of this study is to test the effectiveness of the Best Case/Worst Case-ICU communication tool on quality of communication, clinician moral distress, and ICU length of stay for older adults with serious traumatic injury. Investigators will follow an estimated 4500 patients aged 50 years and older who are in the ICU for 3 or more days and survey 1500 family members and up to 1600 clinicians from 8 sites nationwide.

Eligibility Criteria

This trial is for older adults aged 50 or above who have been seriously injured and are staying in the ICU for at least three days. It's not specified, but typically people with certain medical conditions or treatments that could interfere with the study may be excluded.

Inclusion Criteria

Clinicians who provide care in the trauma ICU (including attending trauma surgeons, fellows, residents, advance practice providers, bedside nurses and medical assistants, respiratory techs and physical therapists, social workers, and chaplains)

I am a family member or considered 'like family' to the patient, over 18, and speak English or Spanish.

I am 50 or older and was in the ICU for 3+ days after a serious injury.

Exclusion Criteria

My family member cannot make their own health decisions.

Clinicians who do not provide care in the trauma ICU

Participant Groups

The study is testing a communication tool called Best Case/Worst Case-ICU to see if it improves how doctors talk about care, reduces stress on clinicians, and possibly shortens ICU stays. The trial will involve patients from multiple hospitals across the country.

2Treatment groups

Experimental Treatment

Active Control

Group I: Best Case/Worst Case-ICU Communication ToolExperimental Treatment1 Intervention

Patients in the intervention group will receive care from a trauma team that routinely uses the Best Case/Worst Case-ICU communication tool.

Group II: Usual CareActive Control1 Intervention

Prior to implementation of the intervention, patients admitted to the trauma ICU will receive usual care. Usual care typically includes conversations focused on isolated problems, disarticulated from the patient's overall health trajectory. This is typified by the systems-base review, routinely summarizing each patient on rounds where the clinician lists each physiologic system, (e.g., neuro, cardiac, pulmonary...) with an assessment and plan to "fix" each abnormality with a new treatment. Deliberation about how these individual treatments align with patient preferences is typically prompted by major events like failure to liberate from a ventilator or imminent death. This pattern of usual care is well characterized and differs from daily scenario planning with the Best Case/Worst Case-ICU communication tool.