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Evaluation of a new limitations and withdrawal of care framework order form in the intensive care unit


The aim of this study was to demonstrate improvements in both staff and patient experiences with end-of-life care. The ICU is a setting where death is common; it has been suggested that 20% of patients in the US die on the ICU [1]. Given that the majority of ICU deaths involve the withholding or withdrawing of treatment [2], the importance of end-of-life care is clear. Despite this frequency, studies suggest that the current quality of end-of-life care is suboptimal on the ICU [3, 4]. As a result, we developed a new framework to address this issue.


We introduced our new framework over a 1-year period; we circulated questionnaires to the staff pre and post study to demonstrate any improvements in end-of-life care.


Our framework was found to be helpful by 97% of respondents and was associated with an improvement in communication and knowledge of end-of-life care. We discovered an increase in the number of staff who felt that patients, along with having their analgesia/sedation needs met, were now experiencing care that was more conducive to a good quality of dying. The number of staff who now felt confident in managing withdrawal of care trended towards a significant P value. See Figure 1 for details.



Quality of end-of-life care was improved with our new framework; however, further research is vital to ensure our patients receive the same kind of evidence-based medicine in their final hours as they did during their acute illness.


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Correspondence to PB Sherren.

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Sherren, P., Turnbull, L. & Yoganathan, S. Evaluation of a new limitations and withdrawal of care framework order form in the intensive care unit. Crit Care 14, P601 (2010).

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  • Public Health
  • Intensive Care Unit
  • Emergency Medicine
  • Patient Experience
  • Acute Illness