PARTNER Family Support Program Launched in Transplant ICU
The ICU Service Center launched the PARTNER family support program in the first of 32 intensive care units—the Transplant ICU— within the UPMC system on June 11, 2018. The PARTNER program is designed to improve the support provided to families of the most critically ill patients in an ICU. PARTNER nurses, who have received intensive communication training, provide the families with emotional and decision support to help them navigate the complex and difficult medical situations and options faced by their loved one.
"The PARTNER intervention was trialed in five UPMC ICUs in 2017 and the results were so promising that UPMC has fast-tracked the program for a phased rollout across all its ICUs," said Douglas White, MD, MAS, Professor and UPMC Chair for Ethics in Critical Care Medicine in the Department of Critical Care Medicine at the University of Pittsburgh.
White added that the PARTNER program resulted in significant improvements in families' ratings of the patient-centeredness of care and the quality of physician-family communication. The results of the PARTNER study were published in the New England Journal of Medicine's May 23, 2018 issue.
The PARTNER program is not a patient care plan, but rather it capitalizes on the communications skills of PARTNER-trained nurses. Program specifics include:
- PARTNER Nurses: A cohort of nurse leaders in each unit undergo intense family support and communication training to be able to assist families and surrogates. Their role is to organize family meetings, conduct daily family check-ins and other timely/frequent communication, and provide families with decision-making support.
- Family Benefits: With these enhanced communication efforts, families will be more knowledgeable and better prepared, which typically results in shorter physician/family meetings. Families and physicians may also experience less distress and conflict when working together to set goals for care.
- Eligible Patients: The PARTNER program is for the most critically ill patients. Enrollment requires that patients lack decision-making capacity and have at least one of these factors: (a) >40% chance of severe long term functional impairment, (b) >40% chance of hospital mortality, (c) >96 hours of mechanical ventilation, as determined by TICU attending physicians.
The rollout for each of the 32-ICUs in the UPMC system is expected to take approximately 28 months and includes two pre-rollout training sessions to allow PARTNER nurses to master the necessary communications skills. The training is conducted by four physicians whose research interests focus on communications skills and ethics required for delivering serious news and managing conflict. They are:
Robert Arnold, MD, Professor of Medicine, Chief, Section of Palliative Care and Medical Ethics and Director of the Institute for Doctor-Patient Communication, Division of General Internal Medicine;
Rene Claxton, MD, MS, Associate Professor of Medicine and Program Director, Hospice and Palliative Medicine Fellowship, Division of General Internal Medicine;
Lisa Podgurski, MD, Medical Director, Magee-Women's Hospital Palliative Care Service, Division of General Internal Medicine;
Jane Schell, MD, Assistant Professor of Medicine, Division of Renal-Electrolyte.