The Timing of Family Meetings in the Medical Intensive Care Unit.
Gina M Piscitello, William M Parham, Michael T Huber and 2 others
PMID 30983374WHAT IT FOUND
In 131 high-risk ventilated ICU patients, only 60 had a family meeting within 72 hours, and median time was 4 days.
Among 54 who died after a meeting, 27 had the first one the same day as or just before death.
Key findings
01Only 60 of 131 patients had a documented family meeting within 72 hours of ICU admission.
02The median time to a family meeting was 4 days, and 17 of 43 patients who stayed in the ICU for more than 7 days had no documented meeting in their first week.
03A timely meeting occurred in 39 of the 55 patients who died and in 21 of the 76 survivors.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single centre, so results may not apply to other hospitals. Only included intubated patients with APACHE II score 25 or higher, so it says nothing about patients who can make decisions or have lower illness severity. Did not include neurological or surgical ICUs, where stays and prognosis may be different. Family meetings were identified from chart notes, not direct observation, and meeting quality was not assessed. Meetings not documented could have been missed, although most surveyed physicians said they document meetings. The 72-hour timely meeting threshold was chosen by the researchers, not set by consensus guideline. Patients with timely meetings were more likely to have septic shock and higher APACHE II scores, so the death association may reflect illness severity. The physician survey included 18 attendings at one centre.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not read the association between timely family meetings and ICU death as proof that meetings cause death. This was an observational chart-review cohort, not a trial, and patients who had timely meetings were more likely to have septic shock and higher APACHE II scores.