Critical Care Workgroup

Mission Statement

To promote excellence in end-of-life care for patients and their families in critical care settings by: defining the gaps between ideal standards and current practices; identifying and disseminating existing resources; developing new resources that respond to prevailing deficiencies; and defining a research, education and policy agenda that advances the goal of excellence in end-of-life care.

Background

Established in January 1999, the Critical Care Workgroup brought together a group of 45 thought leaders in end-of-life in critical care from North America, Europe, Israel, and Australia. Participants established a research agenda, fostered funding from private foundations for critical care end-of-life projects, and developed educational initiatives to inform curricula in end-of-life teaching in North America.

Accomplishments include:

  • A research agenda produced from the first consensus conference prior to workgroup formation, chaired by Randy Curtis and Gordon Rubenfeld, editors of Managing Death in the ICU, Oxford University Press, 2000. (Findings published in Critical Care Medicine 2001; 29(10)2001-6).
  • Funding by The Robert Wood Johnson Foundation of a proposal for the initial phase of formal research arising out of the workgroup agenda. This project included three separate arms:
    1. Description of the epidemiology of death in ICUs in the United States
    2. Articulation of the experience and views of a nationally representative sample of ICU directors with respect to care of patients dying in ICUs
    3. Development of a set of valid and reliable measures of patient and family-centered outcomes and processes of care for patients dying in ICUs that are feasible for use in diverse ICU settings - an audit tool for in-depth evaluation of end-of-life practices in ICUs. This tool (currently under development) will look at various aspects of end-of-life care, including contact between patients, families, and attending physicians; presence of pastoral or social service care; pain and symptom management; family perceptions of end-of-life care, etc. This tool is to be viewed as both a way of describing care at a given institution and as a method of impacting end-of-life care at a given institution. This tool will also provide the foundation for future evaluations and standardization of end-of-life care assessment.
  • Development of a "Compassionate Care" track for the 2001 Society of Critical Care Meeting. This was the first time a major critical care society devoted such a large portion (20%) of an annual meeting to these issues.
  • Formation of a subcommittee to work with the American Board of Internal Medicine on developing an end-of-life module for the certification exam.

Workgroup Products

  • Comprehensive Bibliography and Resource Page for Critical Care End-of-Life Issues
  • Seven End-of-Life Care Domains: Associated Quality Indicators and Related Clinician and Organizational Interventions/Behaviors
  • A Supplement to Critical Care Medicine (2001, Vol. 29, No. 2 "Critical Care: Blending Science and Compassion") was edited by two workgroup members and all supplement authors were workgroup members. (This supplement is available online at http://www.lwwonline.com/ ).
  • Development of a professional and patient version of a video "Compassionate Care in the ICU: Creating a Humane Environment". This video addresses common barriers to optimal end-of-life care and suggests strategies for improvement for caregivers and patients. Copies are available at no charge from the producer by contacting: David Comora, Davids Productions, Montville, NJ (973) 541-2201.
  • Publication of a Research Agenda: Rubenfeld GD, Curtis JR. End-of-Life Care in the Intensive Care Unit: a Research Agenda. Crit Care Med 2001; 29:2001-6. [Medline abstract]
  • "Managing Death in the Intensive Care Unit, The Transition from Cure to Comfort" edited by J. Randall Curtis, MD and Gordon D. Rubenfeld, MD.
    This book can be ordered from Oxford University Press by calling 1-800-451-7556.
  • A content analysis of forms, guidelines, and other materials documenting end-of-life care in intensive care units.

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Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families.