Study: ICU Care Often Costly, Futile

crtical_care_not_always_right_choiceIn a just-published study, some physicians admit that intensive care unit (ICU) patient treatment is often futile and costly.

The study revealed that more than one in 10 patients received ICU care that a physician said was futile, according to LifeScience. The study was conducted by researchers at the University of California, Los Angeles, and RAND Health in Santa Monica, California and was just published in the journal JAMA Internal Medicine.

Some outcomes were not good. More than two-thirds—68 percent—of ICU patients died during their hospitalization stay and 20 died within six months of their discharge, LifeScience reported. Others left the hospital in what were described as “severely compromised health states,” the researchers wrote. Some patients were suffering from severe neurological damage or were placed on life-sustaining machines.

The researchers surveyed 36 physicians who cared for patients deemed critically ill and who were being treated at five ICUs over a three-month period. The team was able to obtain 6,916 assessments of 1,136 patients; patients ranged from 15 to 99 years of age, according to LifeScience.

The researchers found that 904 patients—80 percent—received ICU care that was not considered futile; however, 98 patients (8.6 percent) received what the researchers described as “probably futile treatment,” 123 patients (11 percent), were perceived to have received futile treatment. In 11 cases—1 percent—patients were only considered to have received futile treatment on the day they were transferred to comfort care, LifeScience reported.

Meanwhile, the cost of just one day of futile ICU care is $4,004 per patient. The total amount spent to care for the 123 patients whose treatment was deemed futile—in and out of the ICU—totaled $2.6 million, according to the researchers. The $2.6 million comprised 3.5 percent of the total treatment cost for study participants, LifeScience wrote.

The definition of “futile” differed among the physicians, the researchers said. For instance, 58 percent of the physicians involved in the study said that, to them, a treatment was considered futile when the burden of care significantly outweighed the care’s benefit. Yet, 51 percent said treatment was futile if that treatment never achieved patient goals, 37 percent said treatment was futile if death was imminent, and 30 percent said treatment was futile if the patient was permanently unconscious, according to LifeScience.

Futile care was also seen often in older patients. For every 10-year increase in age, the potential for receiving treatment considered futile increased by 1.6 percent, LifeScience explained. Being more ill, having longer hospital stays, receiving treatment in the ICU, and being transferred from another hospital also increased the likelihood of receiving futile care.

“What ICUs are really good at doing is rescuing patients,” said senior study author Dr. Neil S. Wenger, director of the UCLA Healthcare Ethics Center at the David Geffen School of Medicine. “A critical-care physician wouldn’t want to miss the opportunity to save someone who could be saved.” He noted that, “What this study is trying to get at is that physicians are able to detect when they have done everything… Even at that point, they are having difficulty pulling back, largely because families want to keep pushing forward.”

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