The team and family agree for a specific time to try treatment; This may be 24 to 48 hours or a few days depending on the medical and the patient’s condition.
The staff then maps out special markers that will show if the patient is improving. Perhaps she will be able to breathe with less ventilator support, or receive encouraging blood test results, or become conscious. Then, she may be able to leave the ICU for standard hospital care.
“We want to be able to say that we’ve given enough time to see how they’re going to do,” said Dr. Dong Chang, a critical care specialist at Harbor-UCLA Medical Center and lead author of the study.
“One thing we don’t want is to continue indefinitely,” he said. When patients do not meet the stated goals, he said, “This is often a sign that they will not get better – they will die or end up in a situation they would not like.” In that case, the family may opt for less invasive treatment or comfort care.
The Los Angeles study, which included about 200 ICU patients with a median age of 64, demonstrated how much difference this approach can make. Half of the participants were treated before hospitals adopted time-limited tests; Researchers compared their results to the results of patients whose treatment had become standard practice after such tests.
First, formal family meetings were held for 60 percent of patients to decide. After hospitals introduced time-bound testing, about 96 percent of families had formal meetings – and they took place one day after the patient’s admission, much earlier than five days. The sessions were more likely to include discussion of patient values and preferences and the risks and benefits of treatment.
The average length of stay decreased by one day, a significant change. More important, the proportion of patients staying weeks in the ICU declined sharply, perhaps because less invasive treatments were received and more did not have resuscitation orders.