ICU Communication Tool for Serious Injury

Recruiting at 7 trial locations

Overseen By Kyle J Bushaw, MA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Wisconsin, Madison

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: During ICU stay (3 or more days)

7600 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Best Case/Worst Case-ICU Communication Tool?

Research shows that using structured communication tools in the ICU can significantly improve family satisfaction with decision-making and teamwork among healthcare providers. For example, a study found that implementing a communication algorithm increased family satisfaction scores from 45% to 68% for decision-making and from 64% to 83% for teamwork. ^{1 2 3 4 5}

How does the ICU Communication Tool for Serious Injury differ from other treatments for communication in critically ill patients?

The ICU Communication Tool for Serious Injury is unique because it provides a structured conversation guide to improve communication between healthcare providers and the surrogates of critically ill patients, focusing on understanding patient goals and preferences. Unlike other communication aids, this tool is specifically designed to facilitate shared decision-making in the ICU setting, ensuring that care aligns with the patient's values and wishes. ^{6 7 8 9 10}

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.

Research Team

Margaret L Schwarze, MD, MPP

Principal Investigator

University of Wisconsin, Madison

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 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

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention Implementation

Training of trauma surgeons, trainees, and ICU clinicians to use the Best Case/Worst Case-ICU communication tool

3 months

Training sessions at each site

Treatment

Participants receive care from a trauma team using the Best Case/Worst Case-ICU communication tool

During ICU stay (3 or more days)

Follow-up

Participants are monitored for outcomes such as ICU length of stay, quality of communication, and clinician moral distress

6 months

Treatment Details

Interventions

• Best Case/Worst Case-ICU Communication Tool

Trial Overview 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.

Participant Groups

Group I: Best Case/Worst Case-ICU Communication Tool Experimental Treatment 1 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 Care Active Control 1 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.

Who Is Running the Clinical Trial?

University of Wisconsin, Madison

Lead Sponsor

Trials

1,249

Recruited

3,255,000+

Lehigh Valley Health Network

Collaborator

University of Maryland, Baltimore

Collaborator

Trials

729

Recruited

540,000+

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Shock Trauma - University of Maryland Medical Center

Collaborator

Trials

1

Recruited

7,600+

University of California, Davis

Collaborator

Trials

958

Recruited

4,816,000+

Harborview Injury Prevention and Research Center

Collaborator

Trials

12

Recruited

14,500+

Lehigh Valley Health Network

Collaborator

Trials

4

Recruited

8,100+

Grady Memorial Hospital

Collaborator

Trials

5

Recruited

8,500+

Froedtert Hospital

Collaborator

Trials

10

Recruited

10,700+

References

1. United States pubmed.ncbi.nlm.nih.gov

Improving family satisfaction and participation in decision making in an intensive care unit. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Clinician predictions of intensive care unit mortality. [2022]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

A multifaceted intervention to improve compliance with process measures for ICU clinician communication with ICU patients and families. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

The Impact of Resident Training on Communication with Families in the Intensive Care Unit. Resident and Family Outcomes. [2017]

6. United States pubmed.ncbi.nlm.nih.gov

Use of the Serious Illness Conversation Guide to Improve Communication with Surrogates of Critically Ill Patients. A Pilot Study. [2021]

7. India pubmed.ncbi.nlm.nih.gov

Development of a Standardized Communication Intervention Bundle for Use at a Medical Training Hospital Intensive Care Unit. [2020]

8. Netherlands pubmed.ncbi.nlm.nih.gov

VidaTalk™ patient communication application "opened up" communication between nonvocal ICU patients and their family. [2022]

9. England pubmed.ncbi.nlm.nih.gov

Communication aid requirements of intensive care unit patients with transient speech loss. [2018]

10. United States pubmed.ncbi.nlm.nih.gov

Use of Communication Tools for Mechanically Ventilated Patients in the Intensive Care Unit. [2018]