The overuse of invasive ICU treatments for patients who have advanced illnesses and poor prognoses may prolong suffering and provide minimal benefit. A prospective study was conducted in the medical ICUs of three academic public hospitals to determine whether use of a quality improvement intervention could reduce the duration and intensity of nonbeneficial ICU care for critically ill patients who had advanced illnesses.

Patients at risk for potentially nonbeneficial ICU care because of advanced illnesses were eligible for the study. Time-limited trials were used as the default communication and care-planning approach for these patients. Such trials involve detailed discussions of patients' care preferences and prognosis, followed by agreement between clinicians and patients or their surrogate decision makers to use certain therapies for defined periods of time.

A total of 209 patients were enrolled in the study, including 113 in the preintervention period and 96 in the postintervention period. Formal family meetings occurred more frequently in the postintervention period, and key components of these meetings, such as discussions about the risks and benefits of treatment, were more often addressed during this time period compared with the preintervention period. The median length of stay in the ICU was significantly reduced between the preintervention and postintervention periods. The median hospital length of stay was also shorter following the intervention, and many ICU procedures were used less frequently. Hospital mortality and family satisfaction with care were similar before and after the intervention.

The authors point out that the before-and-after design of the study makes it susceptible to temporal trends that could bias patient selection and study outcomes. Also, it wasn't possible to determine which components of the intervention facilitated changes in physicians' behavior or clinical outcomes.