Crit Care Nurse. 2025 Dec 1;45(6):34-41. doi: 10.4037/ccn2025289.

BACKGROUND: In many intensive care units, inconsistent early goals-of-care discussions contribute to interventions that may not align with patient or family preferences. A standardized approach to identify and reduce nonbeneficial interventions and ensure that treatment aligns with patient-centered goals is lacking.

LOCAL PROBLEM: In a 12-bed medical intensive care unit, nurses observed frequent discrepancies between provided care and patient prognosis, with no standardized process to guide early goals-of-care discussions.

METHODS: This quality improvement project included a 1-month baseline and a 1-month intervention period. The primary measure was the daily count of patients flagged by nursing staff in collaboration with the care team as receiving potentially nonbeneficial or futile care, defined as interventions unlikely to achieve meaningful recovery or inconsistent with patient values. During the intervention, clinicians used the BRIDGE-ICU worksheet-an admissions workflow with key prognostic indicators, patient values, and decision-making steps-to guide early goals-of-care discussions. Baseline and intervention data were compared using an independent t test. Compliance was the percentage of intensive care unit admissions with BRIDGE-ICU document completion within 24 hours.

RESULTS: The average daily count of flagged nonbeneficial interventions decreased from 4.10 before to 3.17 after the intervention, a 22.7% reduction (t = 2.05, P = .045). Compliance reached 67.3% across 110 admissions.

CONCLUSION: Use of the BRIDGE-ICU workflow was associated with a significant reduction in nurse-flagged instances of nonbeneficial or futile care. By providing a structured approach to early goals-of-care discussions, the intervention supported consistent identification and prevention of interventions not aligned with patient-centered goals.

PubMed:41319995 | DOI:10.4037/ccn2025289