Almost all critically ill patients wish to receive therapies that might reasonably promote both the duration and quality of their lives. Yet, too often such patients’ care focuses on only one of these goals or the other. The mismatch between the care that patients would like and the care they receive stems, in part, from the failure of clinicians to engage patients in discussions about their goals and preferences in a timely manner. This pragmatic, stepped-wedge, cluster randomized trial will test the effectiveness of two electronic health record (EHR) interventions. This RCT will be conducted within 19 ICUs of 10 electronically integrated hospitals within the Atrium Health System. The interventions will be designed to increase ICU clinicians’ engagement of critically ill patients and caregivers in discussions about alternative treatment options, including care focused on comfort. This study will test the hypothesis that outcomes can be improved without raising costs by requiring ICU clinicians to (i) document a prognostic estimate and (ii) provide a justification if they choose not to offer patients the option of comfort-oriented care.
The Donaghue Foundation