Quality and safety in the literature: September 2021

Abstract

© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. EVALUATION OF TIME-LIMITED TRIALS AMONG CRITICALLY ILL PATIENTS WITH ADVANCED MEDICAL ILLNESSES AND REDUCTION OF NONBENEFICIAL ICU TREATMENTS JAMA Intern Med. 12 April 2021. Critically ill intensive care unit (ICU) patients with advanced medical illnesses and poor prognoses often receive nonbeneficial care. Determining the appropriate scope of care can be challenging due to initial medical uncertainty regarding prognosis and response to therapy, lack of understanding of patient (or patient surrogate) values, and patient or family expectations that may not reflect the severity of disease. ICU care planning and communication among medical teams and patients/families can be inconsistent and of varying quality. As a result, patients with advanced medical illnesses and poor prognoses often receive invasive treatments that are unlikely to lead to meaningful, functional recovery, and which may also cause harm or prolong suffering. Timelimited trials (TLTs)— agreements between clinicians and patients/families to reevaluate medical therapies after a predefined period of time based on clinical improvement or deterioration—have been recommended as a strategy to reduce nonbeneficial treatments in this patient population. In their multicentre, prospective quality improvement study, Chang and colleagues sought to examine whether using protocoled TLTs as the default ICU care planning approach for patients with advanced medical illnesses would decrease the use of nonbeneficial treatments. The study focused on adult ICU patients at three US academic public hospitals who were at risk for potentially nonbeneficial ICU treatments, either due to underlying medical illnesses or severe acute illness (category 3 in the Society of Critical Care Medicine guidelines), and who were either able to communicate for themselves or had a surrogate. Clinicians were trained to use protocoled TLTs Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas others will highlight unique publications from highimpact medical journals.