SESSION TITLE: Quality Improvement in the ICU I
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 28, 2013 at 01:45 PM - 03:15 PM
PURPOSE: When used to prolong life without achieving an effect that the patient can appreciate as a benefit, critical care interventions are often considered “futile” by health care providers. No study has formally evaluated the opportunity cost of futile treatment. We evaluated how care was delayed and/or compromised for other patients because the intensive care unit (ICU) is full and there were patients receiving futile treatment in the unit.
METHODS: On a daily basis for a 3-month period, we surveyed critical care physicians in five ICUs in one healthcare system to identify patients the clinicians perceived as receiving futile treatment. Days when the ICU was full and when there was at least one patient in the unit receiving futile treatment were identified. For these days, we evaluated the number of patients who had to board in the ED for >4 hours and the number of patients on the transfer-request list who took more than 1 day to be transferred.
RESULTS: Thirty-six critical care specialists made 6916 assessments on 1136 patients. There were 464 (35%) assessments of futile treatment. There were 72 (15.7%) unit-days when the unit was full and had at least one patient receiving futile treatment. During these days, 33 patients boarded in the ED for over 240 minutes after it was determined that they required ICU-level care. Of 22 patients who had to wait for more than one day to be transferred, 9 patients spent 16 days waiting when the ICU was full and at least one patient was receiving futile treatment. Of the 37 patients who never transferred, 2 patients died while waiting.
CONCLUSIONS: The results of this study demonstrate that the burdens of futile treatment extend beyond the patients who receive futile treatment.
CLINICAL IMPLICATIONS: Because the provision of critical care is resource-intensive and not in the best interest of dying patients nor other patients in need of critical care, efforts should explore methods to re-orient treatment to better serve patients.
DISCLOSURE: The following authors have nothing to disclose: Thanh Huynh, Prince Raj, Eric Kleerup, Neil Wenger
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