The team and family agree a certain amount of time to attempt treatment. This can be 24 to 48 hours or a few days, depending on the therapy and the patient’s condition.
The staff then map the particular markers that would show if the patient is improving. Maybe she can breathe, get encouraging blood test results, or regain consciousness with less ventilator assistance. Then she may be able to leave the intensive care unit for hospital care.
“We want to be able to say that we have enough time to see how they are doing,” said Dr. Dong Chang, an intensive care specialist at Harbor-UCLA Medical Center and lead author of the study.
“The only thing we don’t want is to go on indefinitely,” he said. When patients fail to meet set goals, he added, “This is often a sign that they are not getting better – they either die or end up in a state they would not want.” In this case, the family may opt for less aggressive treatment or comfort care.
The Los Angeles study, which enrolled around 200 ICU patients, with an average age of 64, showed how much of a difference this approach can make. Half of the participants were treated before the hospitals adopted time-limited studies. The researchers compared their results with those of patients treated after such studies became standard practice.
Initially, formal family meetings were held for 60 percent of patients to weigh up decisions. After hospitals instituted time-limited studies, nearly 96 percent of families had formal meetings – and they happened much earlier, one day after admitting the patient, rather than five days. The sessions were far more frequent than discussions about the patient’s values and preferences, and the risks and benefits of treatment.
The average length of stay decreased by one day, a significant change. More importantly, the proportion of patients who stayed in intensive care for weeks has fallen sharply, possibly because less invasive treatments were received and more assignments were not resuscitated.
