Quality indicators for end-of-life care in the intensive care unit*

Abstract

These EOLC domains and the associated quality indicators, developed through a consensus process, provide clinicians and researchers with a framework for understanding quality of EOLC in the intensive care unit. Once validated, these indicators might be used to improve the quality of EOLC by serving as the components of an internal or external audit evaluating EOLC continuous quality improvement efforts in intensive care unit settings.

Brief review: Practice variation in end of life care in the ICU: implications for patients with severe brain injury

“…The trend towards more family-centered care for critically ill patients is encouraging but not in itself sufficient. 49 Outside of Canada there is a body of evidence to suggest that end of life care in the ICU falls short of these standards, leading to calls for better palliation. 50,51 The situation in Canada appears more encouraging with families reporting that most patients die in comfort in the ICU 17 and that the families themselves feel supported during the dying process.…”

“Non‐heart‐beating,” or “cardiac death,” organ donation: Why we should care

“…The Robert Wood Johnson Foundation (RWJF) Critical Care End-Of-Life Peer Workgroup developed 53 EOL quality indicators to standardize and measure the quality of EOL care. 41 These quality indicators, organized in 7 domains, focus on delivering patient-and family-centered care and facilitating a "good death" experience in the ICU (Table 3).…”

“…Domains of comprehensive quality indicators of EOLC (n ‫؍‬ 53) 41 Abbreviated quality indicators of EOLC (n ‫؍‬ 18) 46 Patient and family-centered decision making (n ϭ 13) 46 Symptom management and comfort care (n ϭ 10)…”

“…•Emphasize the comprehensive comfort care that will be provided to the patient rather than the removal of life-sustaining treatments •Institute and use uniform quantitative symptom assessment scales appropriate for communicative and noncommunicative patients on a routine basis 41 The Critical Care Peer Workgroup of the Promoting Excellence in End-of-Life Care Project and Critical Care Nursing group recommended certain strategies to overcome barriers to optimal EOLC in the ICU. 42,43 A recent proposal was made to limit the quality measures for EOLC in the ICU to 14 of the original 53 quality indicators.…”

“…26 The process of obtaining donation consent and subsequent donor management protocols for NHBOD deviate from more than 60% of the RWJF quality indicators recommended for optimal EOL care. 35,36,41 Therefore, NHBOD can have a profound impact on the quality of EOL care. There has been a recent proposal to abbreviate the original RWJF quality indicators to include 14 of the 53 (26%) original quality indicators described for optimal EOL care in the ICU (Table 3).…”