Measuring success of interventions to improve the quality of end-of-life care in the intensive care unit.

Because of the severity of illness, the intensive care unit (ICU) is a setting where death is common. Although optimal palliative care should prevent many terminal ICU admissions, the ICU will always remain an important setting for end-of-life care because of the severity of illness of patients in the ICU and because many patients with chronic, life-limiting diseases and their families opt for a trial of intensive care. Therefore, improving the quality of end-of-life care in the ICU is an important endeavor. Furthermore, there are data to suggest that current quality of end-of-life care in the ICU is often poor and that this is an important target for quality improvement. However, as interventions are designed to improve the quality of end-of-life care in the ICU, researchers, clinicians, and quality improvement personnel will need reliable and valid measures to determine whether these interventions do improve the quality of care. In this article, we examine some of the data supporting potential process and outcome measures that could be used to evaluate the success of interventions designed to improve end-of-life care in the ICU.