David Y. Hwang MD
Assistant Professor of Neurology; Staff Neurointensivist, Neuroscience Intensive Care Unit
Neurocritical care; Intensive care unit; Outcome prognostication; Family satisfaction; Consistency of communication by ICU staff; Family anxiety and depression in the ICU; Palliative care
I am currently the Yale PI for the following studies:
Family Satisfaction in the Neuroscience Intensive Care Unit - survey study of Neuro ICU patients' families regarding their impressions of care
Shared Decision Making for Families of Patients with Intracerebral Hemorrhage (ICH) - survey study of general population's priorities in making goals-of-care decisions for patients with ICH
GAMES - study of IV glyburide for cerebral edema following acute ischemic stroke
I am a sub-investigator for the following clinical trials:
i-DEF - study of deferoxamine mesylate for intracerebral hemorrhage
ATACH II - study of aggressive blood pressure lowering for intracerebral hemorrhage
CLEAR III - study of intraventricular tPA for intraventricular hemorrhage
POINT - study of aspirin and clopidogrel for transient ischemic attack
ICTuS 2/3 - study of induced hypothermia in acute ischemic stroke
Our group is actively studying the experience of family members acting as surrogate decision makers for patients admitted to the Yale Neuroscience Intensive Care Unit. We welcome trainees of all levels--including undergraduates, medical students, residents, mid-levels, and nurses--to contact us and become involved. We would be happy to work with any medical students interested in a thesis that encompasses quality improvement, end-of-life care, and/or patient/family satisfaction in ICUs to tailor a project that fits their interests.
Currently, our multidisciplinary team surveys a family member of every patient who is admitted to the Neuro ICU for greater than 3 days regarding their satisfaction with care. We use the FS-ICU 24 survey as our instrument and enroll surviving patients at time of ICU discharge. We also contact family members of patients who pass away about one month after death and ask them to fill out the FS-ICU as well. This infrastructure can serve as the basis for pre- and post-intervention data collection, and the staff of our unit is open to ideas regarding novel interventions to improve the family experience.
Through prior projects, members of our group have previously highlighted the fact that as high as 25% of families of ICU patients perceived "mixed" messages from multiple care providers regarding the clinical course of their admitted relatives. Our group remains interested in studying reasons for why families may receive inconsistent information from different members of the care team.
In addition, our group is either planning on collecting data or analyzing data regarding (1) the effects that role-playing interview exercises among residents may have on patient satisfaction, (2) the relationship between family satisfaction with ICU care and long term incidence of depression/anxiety/PTSD, and (3) the abilities of care providers to predict the functional outcome of patients with diseases such as hemorrhagic stroke.