Rationale: Palliative care in the ICU is an important focus for quality improvement. Methods: We performed a single-hospital, before-after study of a quality-improvement intervention to improve palliative care in the ICU. The intervention consisted of clinician education, local champions, academic detailing, feedback to clinicians, and system support. Consecutive patients who died in the ICU were identified pre- (n= 253) and post-intervention (n=337). Families completed Family Satisfaction (FS-ICU) and Quality of Dying and Death (QODD) surveys. Nurses completed the QODD. The QODD and FS-ICU were scored from 0 to 100. We used Mann-Whitney tests to assess family results and hierarchical linear modeling for nurse results. Results: There were 590 patients who died in the ICU or within 24 hours of transfer; 496 had an identified family member. The response rate for family was 55% (275 of 496) and for nurses 89% (523/590). The primary outcome, the family-QODD, showed a trend toward improvement (pre 62.3, post 67.1), but was not statistically significant (p=0.09). Family satisfaction increased but not significantly. The nurse-QODD showed significant improvement (pre 63.1, post 67.1; p<0.01) and there was a significant reduction in ICU days prior to death (pre 7.2, post 5.8; p<0.01). Conclusions: We found no significant improvement in family-assessed quality of dying or in family satisfaction with care, but significant improvement in nurse-assessed quality of dying and reduction in ICU length of stay with an intervention to integrate palliative care in the ICU. Improving family ratings may require interventions that have more direct contact with family members.