Experts Propose 18 Quality Measures to Improve Care of the Dying in ICUs

Measuring the quality of end-of-life care in the intensive care unit

Members of the Robert Wood Johnson Foundation (RWJF) Critical Care End-of-Life Peer Workgroup conducted a series of five studies to develop ways to optimize care of patients dying in intensive care units (ICUs).

They also developed a set of measures to assess the processes and outcomes of end-of-life care provided in ICUs.

Convened in 1998 under the auspices of RWJF, the workgroup is a task force of 36 nationally recognized clinicians, educators and investigators in critical care and end-of-life care. The group works to develop a national agenda for research, education and clinical efforts to improve the care of patients dying in ICUs.

Key Findings

  • As reported in an article in Critical Care Medicine, (32(3): 638–643, 2004), the researchers estimate that 22 percent of American deaths in 1999 (540,000 deaths) occurred following an ICU admission.

  • As reported in an article in Critical Care Medicine, (34(10): 2547–2553, 2006), researchers identified a number of barriers to end-of-life care in ICUs, including:

    • Lack of advance directives.
    • Competing demands for clinician's time.
    • Suboptimal space for family meetings.
  • As reported in an article in Critical Care Medicine, (31(9): 2255–2262, 2003), researchers identified seven domains in which end-of-life care is provided in the ICU:

    • Patient- and family-centered decision-making.
    • Communication within the team and with patients and families.
    • Continuity of care.
    • Emotional and practical support for patients and families.
    • Symptom management and comfort care.
    • Spiritual support for patients and families.
    • Emotional and organizational support for ICU clinicians.
  • As reported in Journal of Critical Care, (19(2): 108–117, 2004):

    • "Symptom management and comfort care" was the domain of end-of-life care that was integrated most consistently on data entry forms, guidelines and other documents obtained from 15 ICUs.
  • As reported in an article in Critical Care Medicine, (34(11): S404–411, 2006), the research team developed 18 proposed quality measures for end-of-life care provided in the ICU.