Where do we go from here? One intensivist's perspective

Until recently, the intensive care unit has largely escaped the withering criticism of those bent on measuring and improving the quality of care. The evidence base for practice in the intensive care unit is growing, as is the pressure to measure and improve this practice. Viewed as an important part of critical care, the process of eliciting patients' values for life-sustaining treatment, clarifying whether current care fulfills these wishes, resolving conflicts about these assessments, and easing the physical and emotional suffering of patients, families, and staff during critical care would probably qualify as one of the most frequently provided treatments in the intensive care unit. Therefore, as a routinely provided medical therapy, palliative care is certainly an appropriate target for quality improvement activities in critical care. This article considers, from the point of view of a clinical intensivist, the similarities and differences between improving palliative care in the intensive care unit and implementing other practice change to improve the quality of critical care.