Aligning critical care interventions with patient goals: A modified Delphi study.
Alison E Turnbull, Sarina K Sahetya, Dale M Needham
PMID 27593494WHAT IT FOUND
Eight non-emergent ICU interventions should not be offered unless they help a patient's goal.
The agreed list includes tracheotomy, dialysis, feeding tubes, and a suprapubic urinary catheter. Use them as cues to check goals before proceeding.
Key findings
01Eight of 11 candidate recommendations achieved consensus that the intervention should not be offered unless it will help achieve the patient's treatment goal.
02The eight consensus interventions were permanent feeding tube, permanent dialysis catheter, suprapubic urinary catheter, tracheotomy, long-term venous catheter, pulmonary artery catheter, in-hospital dialysis, and temporary NG feeding tube.
03All eight recommendations achieved consensus among both clinicians and patient or family members.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The panel was small and came from 6 hospitals in one mid-Atlantic region, so it may not represent other hospitals, specialty ICUs, or regions. Patients and family members were volunteers over age 49, and clinicians were volunteers, so their views may differ from those of peers. The study produced consensus recommendations, not tested treatment outcomes, so it cannot show that avoiding an intervention improves health or reduces harm. Round 2 had 11 of 12 patient-family representatives complete, and Round 3 had 22 panel members complete. Patient and family members generally chose less extreme ratings than clinicians in Round 3, which may reflect less confidence in making informed decisions about interventions. Patient and family members did not review educational materials for all 59 interventions in Round 1.
The easy way to misread this
Do not read the list as evidence that these eight ICU interventions are harmful or should be withheld. The study reached expert consensus on when to discuss patient goals, not on treatment outcomes.