Intensive care unit length of stay is reduced by protocolized family support intervention: a systematic review and meta-analysis

Abstract

PurposeThis study aimed to elucidate the impact of protocolized family support intervention on length of stay (LOS) in the intensive care unit (ICU) through a systematic review and meta-analysis.MethodsMedline, EMBASE, the Cochrane Central Register of Controlled Trials, and other web-based databases were referenced since inception until November 26, 2018. We included randomized-controlled trials wherein protocolized family support interventions were conducted for enhanced communication and shared medical decision-making. LOS (in days) and mortality were evaluated using a random-effects model, and adjusted LOS was estimated using a mixed-effects model.ResultsWe included seven randomized-controlled trials with 3477 patients. Protocolized family support interventions were found to significantly reduce the ICU LOS {mean difference\u2009=\u2009−\u20090.89 [95% confidence interval (CI)\u2009=\u2009−\u20091.50 to −\u20090.27]} and hospital LOS [mean difference\u2009=\u2009−\u20093.78 (95% CI\u2009=\u2009−\u20095.26 to −\u20092.29)]; the results of the mixed-effect model showed that they significantly reduced ICU LOS after adjusting for the therapeutic goal [mean difference\u2009=\u2009−\u20091.30 (95% CI\u2009=\u2009−\u20092.35 to −\u20090.26)], methods of measurement [mean difference\u2009=\u2009−\u20090.89 (95% CI\u2009=\u2009−\u20091.55 to −\u20090.22)], and timing of intervention [mean difference\u2009=\u2009−\u20091.05 (95% CI\u2009=\u2009−\u20092.05 to −\u20090.05)]. Similar results were found after adjusting for patients’ disease severity [mean difference\u2009=\u2009−\u20091.21 (95% CI\u2009=\u2009−\u20092.03 to −\u20090.39)] and the trim-and-fill method [mean difference\u2009=\u2009−\u20090.86 (95% CI\u2009=\u2009−\u20091.44 to −\u20090.28)]. There was no difference in mortality rate in ICU and hospital between the protocolized intervention and control groups.ConclusionsProtocolized family support intervention for enhanced communication and shared decision-making with the family reduced ICU LOS in critically ill patients without impacting mortality.