ICU Diaries: A Simple, Multidisciplinary Bedside Intervention to Improve Patient and Family Outcomes After Severe Acquired Brain Injury

Grant Application

Jonathan Elmer, MD, MS, and Karen Nigra, RN, of UPMC Presbyterian

 

Proposed Innovation

Critically ill patients who have sustained a severe brain injury due to a traumatic accident or cardiac arrest often experience nightmares, delusions, stress, depression, and even post-traumatic stress disorder related to their time in the intensive care unit (ICU).

Through this project, family members, and hospital staff at UPMC Presbyterian will keep ICU Diaries detailing how the patient came to the ICU, what happened there, and the progress made during the patient’s hospital stay. The goal is to help patients fill in the gaps and cope with emotional problems stemming from memories based on distorted and frightening hallucinations and delusions.

 

Improvements in Action

Although the ICU Diaries are a simple bedside intervention, implementation requires staff and family education. As part of this project, informational booklets, sample diaries, and nursing guidelines have been created based on similar programs developed in Europe. In-service training sessions also will be developed for staff in the NeuroTrauma and Cardiac ICUs. Feedback solicited from staff and families will help ensure use of the ICU Diaries is acceptable and minimally burdensome.

 

Results — In Progress

Routine use of daily diary entries for ICU patients admitted following a severe traumatic brain injury or cardiac arrest is expected to close a gap in the quality of care and improve long-term emotional outcomes for patients. Data will be collected from two groups of ICU patients — pre-intervention and post-intervention — three to six months following discharge to measure the difference in outcomes relating to symptoms of post-traumatic stress, memories or delusions from the ICU stay, depression, and sleep problems.