A PROPOSAL It is clear there are multiple barriers to ensuring that ICU patients at high risk of dying or profound functional impairment receive care that is consistent with their values and preferences and imposes a minimum burden of pain and uncomfortable symptoms. To address these barriers. I propose that ICUs institute a mandatory review of goals of care, conducted at 48 hours after admission with all ICU patients at high risk of dying or serious functional impairment, or with their surrogates. A pri- or study by Lilly etal. demonstrated the effectiveness of meetings at 72 hours post-ICU admission for similarly ill patients, and this general timeframe has been recommended by Nelson, Walker, Luhrs, Cortez, ue, however, for an earlier timeframe for meetings hours to formally establish that ongoing LST is consistent with a patient's preferences and values.