Prognosticating Outcomes and Nudging Decisions with Electronic Records in the Intensive Care Unit Trial Protocol

Area of Science:

• Critical Care Medicine
• Palliative Care
• Health Informatics

Background:

• Expert recommendations for discussing prognosis and palliative care with high-risk, critically ill patients are often overlooked by intensive care unit (ICU) clinicians.
• The optimal method to promote these crucial conversations and prevent unwanted aggressive treatments remains unclear.

Purpose of the Study:

• To evaluate the effectiveness of two electronic health record (EHR) interventions designed to enhance ICU clinician engagement with critically ill patients and their families regarding end-of-life care options.
• To determine if these EHR interventions improve the quality of care and patient-centered outcomes for high-risk ICU patients.

Main Methods:

• A 33-month pragmatic, stepped-wedge cluster randomized trial involving 17 ICUs across 10 hospitals.
• Interventions included requiring documentation of functional prognostic estimates (A) and/or justification for not offering comfort-focused care (B).
• Adult patients with a life-limiting illness and acute respiratory failure requiring mechanical ventilation for ≥48 hours were enrolled.

Main Results:

• The primary outcome measured was hospital length of stay.
• Secondary outcomes included clinical results, palliative care processes, and nurse-assessed quality of dying and death.

Conclusions:

• The PONDER-ICU study aims to improve end-of-life care communication and outcomes through EHR-based interventions.
• Findings will inform strategies for better integrating prognostic discussions and palliative care into critical care settings.