Time-limited Trials in the Emergency Department

Launched by BRIGHAM AND WOMEN'S HOSPITAL · Apr 17, 2024

Keywords

ClinConnect Summary

This clinical trial, called "Time-limited Trials in the Emergency Department," is exploring how structured conversations between doctors and seriously ill older adults (or their family members) can help make better decisions about using intensive care services when they are admitted to the hospital. The goal is to ensure that patients and their families are fully involved in the decision-making process, especially in situations where the patient's condition is very serious.

To be eligible for this study, patients must be at least 50 years old with a serious illness or at least 75 years old, and they should be admitted to the intensive care unit from the emergency department. If the patient cannot participate due to conditions like confusion or severe illness, a family member (surrogate) can take part in the discussion instead. Participants in the trial can expect to engage in a conversation with their healthcare team about their goals and preferences for care, helping to shape the treatment they receive during their hospital stay. The study is currently looking for both doctors and patients to participate, and it aims to improve communication and decision-making in critical care settings.

Gender

ALL

Eligibility criteria

• Physician's eligibility:
• Inclusion Criteria:
• • Attending physicians, resident physicians, or mid-level providers working in the ED who are willing to be randomized to become the study interventionists.
• Exclusion Criteria:
• • Emergency clinicians unwilling to consent and be randomized to intervention TLT training.
• Patient's eligibility:
• • The subjects will be seriously ill older adults, or their surrogates being cared for by the participating emergency clinicians (both the intervention or control arms). If the emergency clinicians determine that the patient is not able to provide consent due to cognitive impairment, dementia, delirium, or critical illness, the surrogates will participate in the TLT conversations.
• Inclusion Criteria:
• • 1. ≥50 years or older with ≥one serious life-limiting illness\* being admitted to the intensive care unit in the ED; or
• • 2. ≥75 years or older being admitted to intensive care unit in the ED; or
• • 3. ED clinicians will not be surprised if the patient died in the current hospital admission or in the near future; and
• • 4. English speaking \*Serious illness criteria with high one-year mortality are selected based on best practice recommendations such as 1) stage III/IV or metastatic cancer; 2) end-stage renal disease on dialysis; 3) chronic heart/lung disease requiring home oxygen supplementation or experiencing shortness of breath with walking; 4) moderate to severe dementia (surrogate required for enrollment); or 5) ≥2 hospitalizations or ED visits in the past six months.
• Exclusion Criteria:
• • 1. Unable or unwilling to provide informed consent; or
• • 2. Non-English speaking; or
• • 3. Clinically inappropriate, determined by emergency clinicians, and no surrogate is available