Table 1 Questions (Q 1–50) regarding EOL and Categories (C 1–3)

Prognosis and outcome (Q 1–7)

 Q1–3 Do you use scores for estimation of prognosis, such as SAPS II or SOFA, to estimate a patient’s individual prognosis? C2

 Q1 In general? C2

 Q2 With ICU stay <24 h? C2

 Q3 With ICU stay >24 h? C2

 Q4 Do you receive outcome data regarding long-term survival after hospital discharge? C3

 Q5 Do you receive outcome data from patients discharged to other hospitals or rehabilitation centers? C3

 Q6 Do you receive outcome data from patients discharged home? C3

 Q7 Do you use outcome data from your hospital for your decisions? C3

Goals of care (curative versus palliative) (Q 8–18)

 Q8 Do you use principles of palliative care? C1

 Q9 Do you address goals of care within 72 h of ICU admission? C1

 Q10 Do you discuss goals of care and prognosis with patients and families? C1

 Q11 Do you document the items and results of these conversations with patients? C1

 Q12 Do you document the items and results of these conversations with relatives? C1

 Q13 Do you discuss indications in an interdisciplinary manner? C1

 Q14 Do you discuss whether goals are achievable? C1

 Q15 Do you discuss ineffective therapy? C1

 Q16 Do you establish feasible and realistic treatment goals? C1

 Q17 Do you discuss whether a desirable quality of survival is achievable? C1

 Q18 Do you decide on and document to allow natural death (AND)? C1

Patient autonomy (Q 19–26)

 Q19 Do you document the assumed consent of the patient? C1

 Q20 Do you document conversations with relatives regarding the assumed consent of the patient? C1

 Q21 Do you document conversations with the patients regarding their priorities regarding their way of life, their perceptions of quality of live, and their wishes for the future? C1

 Q22 Do you prepare adequate advanced health care directives (AHDC) which are accepted by all involved parties in case of ICU care and can be applied directly? C3

 Q23 Do you have guidelines for dealing with delicate wishes of patients? C3

 Q24 Do you have an ethics committee? C1

 Q25 Do you perform ethics councils? C3

 Q26 Do you perform interdisciplinary ethics case reviews? C3

Standard operating procedures (SOPs), quality management (Q 27–29)

 Q27 Do you have SOPs for psychosocial problems? C3

 Q28 Do you have SOPs for spiritual problems? C3

 Q29 Do you have a room for taking farewell? C1

Which changes in goals of care do you execute in these instances? (Q 30–37)

 Q30–31 In case of further deterioration of defined organ functions in patients with advanced severe underlying disease or relevant functional impairments with primarily equal treatment goals of a potentially reversible acute process (i.e., treatment of pneumonia, pulmonary embolism, mass reduction surgery of tumor), do you perform:

 Q30 Continuation and escalation of therapy with all consecutive life-sustaining activities? C1

 Q31 Change in goals of care, adjustment of therapy to the new goals, usually by limitations of care? C1

 Q32 DNR (Do Not Resuscitate) C1

 Q33 DNE (Do Not Escalate) C1

 Q34 RID (Re-evaluate Indication and De-escalate) C3

 Q35 CTC (Comfort Terminal Care) C3

 Q36 Is the decision to changing goals of care authorized by a physician, communicated during handover of duty, checked daily and documented in the patient chart / patient data management system? C1

 Q37 Do you have a checklist” items for intensive care medicine for individual changes in treatment goals”? C3

Nursing aspects (Q 38–40)

 Q38 Do you integrate nurses’ opinions? C1

 Q39 Do you implement palliative care concepts, such as adaption of oral care, noise, light, basal stimulation? C1

 Q40 Is the nursing staff educated in palliative care? C3

Concepts of care in the terminal phase (Q 40–50)

 Q41 Do you use SOPs for EOL? C3

 Q42 Do you do an appraisal of the initial situation? C1

 Q43 Is there care for others, such as relatives or the primary care physician, once the patient has died? C3

 Q44 Do you use the Liverpool pathway of care? C2

 Q45 Do you administer diaries of patients? C2

 Q46 Do you administer diaries of relatives? C2

 Q47 Do you involve relatives to attend when death occurs? C1

 Q48 Do you offer attendance by psychologists, social workers, spiritual care? C1

 Q49 Do you consider intercultural aspects? C1

 Q50 Are visiting hours handled flexible according to the needs of the relatives? C1