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© 2016 Springer-Verlag Berlin Heidelberg and ESICM The concept of intensive care unit (ICU) strain—the collision of sick patients, frequent emergencies, tense emotions, and death’s uncertainty in a setting with constrained resources and time—is perennial. Those who care for critically ill patients in busy ICUs feel this strain viscerally and sense that it worsens clinician morale, makes us feel less efficient and satisfied, reduces quality of trainee education, and may negatively impact patient care. However, while the notion of ICU strain is not new, operationalizing this concept to allow its investigation

Does increased ICU strain prompt clinicians to communicate with families about end-of-life issues earlier?