Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Feb 1;183(3):348-55.
doi: 10.1164/rccm.201006-1004OC. Epub 2010 Sep 10.

Effect of a quality-improvement intervention on end-of-life care in the intensive care unit: a randomized trial

J Randall Curtis  1 , Elizabeth L Nielsen, Patsy D Treece, Lois Downey, Danae Dotolo, Sarah E Shannon, Anthony L Back, Gordon D Rubenfeld, Ruth A Engelberg
Affiliations
Randomized Controlled Trial

Effect of a quality-improvement intervention on end-of-life care in the intensive care unit: a randomized trial

J Randall Curtis et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Because of high mortality, end-of-life care is an important component of intensive care.

Objectives: We evaluated the effectiveness of a quality-improvement intervention to improve intensive care unit (ICU) end-of-life care.

Methods: We conducted a cluster-randomized trial randomizing 12 hospitals. The intervention targeted clinicians with five components: clinician education, local champions, academic detailing, clinician feedback of quality data, and system supports. Outcomes were assessed for patients dying in the ICU or within 30 hours of ICU discharge using surveys and medical record review. Families completed Quality of Dying and Death (QODD) and satisfaction surveys. Nurses completed the QODD. Data were collected during baseline and follow-up at each hospital (May 2004 to February 2008). We used robust regression models to test for intervention effects, controlling for site, patient, family, and nurse characteristics.

Measurements and main results: All hospitals completed the trial with 2,318 eligible patients and target sample sizes obtained for family and nurse surveys. The primary outcome, family-QODD, showed no change with the intervention (P = 0.33). There was no change in family satisfaction (P = 0.66) or nurse-QODD (P = 0.81). There was a nonsignificant increase in ICU days before death after the intervention (hazard ratio = 0.9; P = 0.07). Among patients undergoing withdrawal of mechanical ventilation, there was no change in time from admission to withdrawal (hazard ratio = 1.0; P = 0.81).

Conclusions: We found this intervention was associated with no improvement in quality of dying and no change in ICU length of stay before death or time from ICU admission to withdrawal of life-sustaining measures. Improving ICU end-of-life care will require interventions with more direct contact with patients and families. Clinical trial registered with www.clinicaltrials.gov (NCT00685893).

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Development of the sample for (A) family members and (B) nurses.
See this image and copyright information in PMC

Comment in

References

    1. Cook D, Rocker G, Marshall J, Sjokvist P, Dodek P, Griffith L, Freitag A, Varon J, Bradley C, Levy M, et al. Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. N Engl J Med 2003;349:1123–1132. - PubMed
    1. Azoulay E, Metnitz B, Sprung CL, Timsit JF, Lemaire F, Bauer P, Schlemmer B, Moreno R, Metnitz P. End-of-life practices in 282 intensive care units: data from the SAPS 3 database. Intensive Care Med 2009;35:623–630. - PubMed
    1. The SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients: The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA 1995;274:1591–1598. - PubMed
    1. Nelson JE, Meier D, Oei EJ, Nierman DM, Senzel RS, Manfredi PL, Davis SM, Morrison RS. Self-reported symptom experience of critically ill cancer patients receiving intensive care. Crit Care Med 2001;29:277–282. - PubMed
    1. Azoulay E, Pochard F, Kentish-Barnes N, Chevret S, Aboab J, Adrie C, Annane D, Bleichner G, Bollaert PE, Darmon M, et al. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 2005;171:987–994. - PubMed

Publication types

Associated data