Economic Feasibility of Staffing the Intensive Care Unit with a Communication Facilitator

In Annals of the American Thoracic Society, Nita Khandelwal and colleagues, including Norma Coe, assess the economic feasibility of staffing intensive care units (ICUs) with a communication facilitator. This person assists families in complex decision-making, improves patient-provider communication, and ensures that care is consistent with patient values and goals. The authors conducted a randomized trial with an ICU communication facilitator, and also looked at financial hospital records. Units that had a facilitator saw significantly reduced daily average ICU costs, and maximal weekly savings when working with low-mortality patients. Despite more contacts, families of surviving patients spent less time per encounter with facilitators than did families of deceased patients. These findings suggest that a full-time communication facilitator in the ICU may improve the quality of care while simultaneously reducing costs. However, this intervention is most likely to be more cost-effective in a lower-mortality population.