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Study protocol for a randomized controlled trial: Integrating the 'Time-limited Trial' in the emergency department
Tadayuki Hashimoto1,2, Rachel K Putman3, Anthony F Massaro3
1Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
Plos One
|December 23, 2024
Summary
This pilot study evaluates Time-Limited Trials (TLTs) in the Emergency Department (ED), aiming to improve patient-centered care and palliative integration for critically ill patients. Findings will assess feasibility and acceptability of ED-initiated TLTs.
Area of Science:
- Critical Care Medicine
- Palliative Care
- Health Services Research
Background:
- Time-Limited Trials (TLTs) are structured discussions for seriously ill patients, focusing on values, prognosis, and shared decision-making for time-bound therapies.
- Evidence suggests TLTs enhance patient-centered care in Intensive Care Units (ICUs).
- TLTs have not been previously evaluated in the Emergency Department (ED) setting.
Purpose of the Study:
- To assess the feasibility and acceptability of initiating TLTs in the ED.
- To investigate the potential of ED-initiated TLTs for patient-centered intensive care utilization.
- To improve palliative care integration for critically ill older adults in the ED and ICU.
Main Methods:
- A clinician-level, pilot randomized clinical trial involving 40 ED clinicians.
- Feasibility will be measured by the time taken to conduct TLTs.
- Clinician and patient-reported acceptability and clinical outcomes will be tracked.
Main Results:
- This section is for pre-results; specific findings are not yet available.
- The study is registered on ClinicalTrials.gov (ID: NCT06378151).
- Data collection is ongoing for feasibility, acceptability, and clinical outcomes.
Conclusions:
- This protocol outlines an investigation into the utility of ED-initiated TLTs.
- The study aims to bridge palliative care needs between the ED and ICU.
- Successful implementation could enhance end-of-life care discussions for critically ill patients.
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