S2 Appendix -

<div><p>Introduction</p><p>Time-limited trial (TLT) is a structured approach between clinicians and seriously ill patients or their surrogates to discuss patients’ values and preferences, prognosis, and shared decision-making to use specific therapies for a prespecified period of time in the face of prognostic uncertainty. Some evidence exists that this approach may lead to more patient-centered care in the intensive care unit; however, it has never been evaluated in the emergency department (ED). The study protocol aims to assess the feasibility and acceptability of TLTs initiated in the ED.</p><p>Methods and analysis</p><p>We will conduct a parallel group, clinician-level, pilot randomized clinical trial among 40 ED clinicians. We will measure feasibility (e.g., the time it takes to conduct the TLTs by ED clinicians) and clinician and patient-reported acceptability of the TLT, and also track patients’ clinical outcomes via medical record review.</p><p>Discussion</p><p>This study protocol will investigate the potential of TLT initiated in the ED to lead to patient-centered intensive care utilization. By doing so, the study intends to improve palliative care integration for seriously ill older adults in the ED and intensive care unit.</p><p>Trial identifier and registry name</p><p>ClinicalTrials.gov ID: <a href="https://clinicaltrials.gov/study/NCT06378151" target="_blank">NCT06378151</a> <a href="https://clinicaltrials.gov/study/NCT06378151" target="_blank">https://clinicaltrials.gov/study/NCT06378151</a>; Pre-results; a randomized controlled trial: Time-limited Trials in the Emergency Department.</p></div>