A Communication Tool to Improve Communication in the ICU

University of Wisconsin (UW)

Status: Active, not recruiting

Conditions: Communication; Serious Injury

Treatments: Other: Best Case/Worst Case-ICU Communication Tool

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT05780918

R01AG078242-01 (U.S. NIH Grant/Contract)

A539750 (Other Identifier)

Protocol Version 5/5/2025 (Other Identifier)

2022-0334

Details and patient eligibility

About

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.

Full description

This is a multisite, stepped-wedge, randomized clinical trial. At the start of the study, investigators will randomly assign each site to the time when the intervention team will train all trauma surgeons, trainees, and ICU clinicians to use the Best Case/Worst Case-ICU tool. Participants in the intervention group will receive care from a trauma team that routinely uses the Best Case/Worst Case-ICU communication tool. Participants in the control group will receive usual care.

The study team will follow an estimated 4,500 patients with the highest post-injury mortality: aged 50 years and older with an ICU length of stay of 3 or more days. They will administer surveys to family members (quality of communication) and clinicians (moral distress) and obtain patient-level outcomes (ICU length of stay (LOS)), clinical data, and demographics from the Trauma Quality Improvement Program (TQIP) national registry.

Objectives:

• Aim 1: To test the effectiveness of the Best Case/Worst Case-ICU communication tool on improving the quality of communication in the trauma ICU.
• Aim 2: To test the effectiveness of the Best Case/Worst Case-ICU communication tool on reducing clinician moral distress in the ICU.
• Aim 3: To test the effectiveness of the Best Case/Worst Case-ICU communication tool on reducing ICU length of stay.

Enrollment: 7,600 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Patients

Inclusion Criteria:

• aged 50 and older
• admitted to the ICU for 3 or more days after serious injury

Exclusion Criteria:

• none

Family Members

Inclusion Criteria:

• aged 18 and older
• patient's family member or informally designated "like family" or primary surrogate decision maker
• speak English or Spanish

Exclusion Criteria:

• does not have decision-making capacity

Clinicians

Inclusion Criteria:

• 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)

Exclusion Criteria:

• do not provide care in the trauma ICU

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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7,600 participants in 2 patient groups

Best Case/Worst Case-ICU Communication Tool

Experimental group

Description:

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

Treatment:

Other: Best Case/Worst Case-ICU Communication Tool

Usual Care

No Intervention group

Description:

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.