NCT06378151

Time-limited Trials in the Emergency Department

Time-limited Trials in the Emergency Department: A Randomized Trial

• Status: Active Not Recruiting
• Phase: N/A
• Study type: Interventional
• Enrollment: 40 (estimated)
• Sponsor: Brigham and Women's Hospital · Academic / Other
• Sex: All
• Age: 18 Years
• Healthy volunteers: Not accepted

Summary

A randomized controlled trial of a structured conversation between clinicians and patients/surrogates to facilitate shared decision-making for intensive care use in seriously ill older adults being admitted to the intensive care unit from the emergency department.

Detailed description

A randomized controlled trial of a structured conversation between clinicians and patients/surrogates to facilitate shared decision-making for intensive care use (i.e., Time-Limited Trial, TLT) in seriously ill older adults being admitted to the intensive care unit from the emergency department (ED). The goal is to evaluate the feasibility and acceptability of TLT initiated in the ED for seriously ill older adults who are starting intensive care. The main questions it aims to answer are: * Is TLT feasible to be conducted by trained ED clinicians? * Do patients or their surrogates find TLT acceptable in understanding and respecting their end-of-life care preferences? Participants will be: * Attending physicians, resident physicians, or mid-level providers working in the ED who are willing to be randomized to become the study interventionists to conduct TLT conversations. * Seriously ill older adults receiving intensive care in the ED. Researchers will compare clinicians using TLT with those providing usual care to see if TLT leads to improved patient-centered decision-making and better alignment with patients' end-of-life care preferences.

Conditions

• Emergencies

Interventions

Type	Name	Description
OTHER	TLT training	Emergency clinicians assigned to the intervention group will receive the following training and resources. 1. The TLT Conversation Guide: The structured conversation guide entails discussing patients' values and goals, prognosis, and shared decision-making to use a trial of intensive care. Originally used in ICU settings, we systematically refined the guide to be used in the ED incorporating inputs from patient advisors' and emergency clinicians' inputs. 2. Clinician Training: The clinician training will include a one-hour didactic on research methodologies and serious illness communication skills, followed by a four-hour communication training with trained actors. 3. EHR Documentation: An EHR template for documenting the TLT conversation findings has been developed. 4. Intensivist Communication: A standard template to communicate the TLT conversation findings to the intensivists has been developed.

Timeline

• Start date: 2024-04-12
• Primary completion: 2025-12-31
• Completion: 2026-10-01
• First posted: 2024-04-22
• Last updated: 2026-03-19

Locations

1 site across 1 country: United States