ALISO VIEJO, Calif. - Dec. 2, 2025 – Conversations with newly admitted patients and their families about goals of care are designed to provide clarity and align treatment with their preferences, but an inconsistent approach may instead lead to nonbeneficial or futile care.
Without structure, discussions with a patient and family members about the patient’s prognosis and quality of life may heighten anxiety and compromise informed decision-making. In addition, clinicians often point to interventions they perceive as contributing to unnecessary suffering or are unlikely to achieve meaningful recovery as key factors related to nurses’ burnout and moral distress.
The BRIDGE-ICU (Balancing Realistic Interventions, Defined Goals and Expectations in the ICU) workflow was developed to provide a consistent foundation for goals-of-care conversations that clinicians hold with patients and their families. The evidence-based tool helps a clinician have a structured, meaningful discussion with a patient and family members soon after the patient’s admission to an intensive care unit (ICU).
“BRIDGE-ICU: A Novel Initiative to Align Goals of Care With Prognosis, Functional Goals, and Quality of Life in Critical Care” details development and pilot implementation of an admissions workflow to guide discussions with critically ill patients and their families. The article is published in Critical Care Nurse (CCN).
Lead author Bryan Frankovitch, DNP, APRN, ACNPC-AG, CCRN-CMC, is a vascular neurology nurse practitioner, acute and critical care, Ayer Neuroscience Institute, Hartford Hospital, Connecticut. The initiative was conducted while he was a student in the DNP program at University of Connecticut School of Nursing.
“For many years, medicine has often left families to navigate complex decisions without clear clinical guidance,” he said. “BRIDGE-ICU brings structure to these conversations at the time of admission and pairs patients’ goals and values with expert recommendations, so they receive support — not a menu of choices without context.”
BRIDGE-ICU uses a one-page, clinician-facing worksheet that sequentially addresses six key elements, beginning with the patient’s goals and values. It then reviews initial lab results and clinical data, discussing whether the patient’s goals align with the clinical situation and evaluating the likelihood of benefit from lifesaving interventions, such as resuscitation. The provider offers clear, expert guidance on appropriate goals of care, such as restorative care, conservative management or comfort measures. The final element documents the patient’s or family’s decision regarding code status and goals of care. The full worksheet is available online as part of the journal article.
The workflow was piloted in a 12-bed medical ICU at Hartford Hospital, with the baseline phase in August 2024, followed by the intervention phase in September 2024. The project used the term “flagged patient” to track those identified by a resource registered nurse in the unit as a patient receiving potentially nonbeneficial or futile care, using predefined criteria and collaborative clinical judgment.
Data analysis revealed a statistically significant reduction in flagged cases of potentially nonbeneficial care after BRIDGE-ICU was implemented. The average daily number of patients flagged during the baseline phase was 4.10, which decreased to 3.17 during the intervention phase, a 22.7% reduction. Flagged instances were counted daily and may reflect repeat observations for the same patient over multiple days, underscoring both the prevalence and persistence of nonbeneficial care.
Of 110 total ICU admissions during the intervention phase, 74 worksheets were completed within 24 hours of admission, yielding a compliance of 67.3%.
Although nurses were not the primary drivers of the conversations with patients and families, many reported noticeable reductions in moral distress. The flagging process provided a structured way to express concerns about futile care, and the use of BRIDGE-ICU reassured them that thorough, values-based discussions were taking place.
As AACN’s bimonthly clinical practice journal for acute and critical care nurses, CCN is a trusted source of information related to the bedside care of critically and acutely ill patients. Access the article abstract and full-text PDF by visiting the CCN website at http://ccn.aacnjournals.org.
About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in acute, progressive and critical care settings. CCN enjoys a circulation of about 130,000 and can be accessed at http://ccn.aacnjournals.org/.
About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.
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