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

Almost all critically ill patients wish to receive therapies that might reasonably promote both the duration and quality of their lives. Yet too often, such patients’ care focuses on only one of these goals or the other.  The mismatch between the care that patients want and the care they receive stems, in part, from clinicians’ failures to engage patients’ in discussions about their goals and preferences in a timely manner.

This pragmatic, stepped-wedge, cluster randomized trial will test the effectiveness of two electronic health record (EHR) interventions designed to increase ICU clinicians’ engagement of critically ill patients and caregivers in discussions about alternative treatment options, including care focused on comfort. The study will test the hypothesis that outcomes can be improved without raising costs by requiring ICU clinicians to (i) document a prognostic estimate  and (ii) provide a justification if they choose not to offer patients the option of comfort-oriented care.