Prognosticating Outcomes and Nudging Decisions with Electronic Records in the ICU (PONDER-ICU)

Most critically ill patients want care that promotes the length and quality of their lives. Too often, their care focuses on only one of these goals. There is a mismatch between the care that patients want and the care they receive. This is because, sometimes, clinicians do not talk to patients about their goals and wants. Or, clinicians do not do it soon enough. This pragmatic, stepped-wedge, cluster-randomized trial tested two electronic health record interventions in 17 intensive care units (ICUs) at 10 hospitals. The interventions were designed to increase ICU clinicians’ engagement of critically ill patients and caregivers in discussions about alternative treatment options, including care focused on comfort. We hypothesized outcomes might improve by requiring ICU clinicians to assess patients’ prognosis at 6 months and provide a justification if they did not offer patients the option of comfort-oriented care.

Atrium Health

The Donaghue Foundation