Intensive care units (ICUs) offer many life-saving benefits to critically ill patients. However, according to a new UCLA study, more than one in 10 patients being treated in these units do not have some degree of health restored; instead, the futile care they receive merely prolongs the death process—and accrues a huge hospital bill. The results of the study were published on September 9 in the journal JAMA Medicine.
The researchers note that physicians often perceive as futile ICU interventions that prolong life without achieving an effect that the patient can appreciate as a benefit. Therefore, they conducted a study to determine the prevalence and cost of critical care perceived to be futile. “The biggest issue, more important than the cost issue, is the use of highly advanced medical care that was designed to rescue people that instead gets used to prolong the dying process,” explained senior author Dr. Neil Wenger, director of the UCLA Healthcare Ethics Center at the David Geffen School of Medicine.
Before beginning the study, the researchers first convened a group of 13 doctors who worked in critical care to agree on a definition of futile treatment. Categories included care for patients who were permanently unconscious or for whom death was imminent, or treatment that could not achieve the patient’s goals. Then, on a daily basis for three months, they surveyed critical care specialists in five ICUs at an academic healthcare system to identify patients whom the physicians believed were receiving futile treatment. They then identified patient and clinician characteristics associated with patients perceived to be receiving futile treatment. They estimated the total cost of futile treatment by summing the charges of each day of receiving perceived futile treatment and converting to costs. The main outcome measure of the study was the prevalence of patients perceived to be receiving futile treatment.
The investigators found that during a three-month period, there were 6,916 assessments by 36 critical care specialists of 1,136 patients. Of these patients, 904 (80%) were never perceived to be receiving futile treatment, 98 (8.6%) were perceived as receiving probably futile treatment,
123 (11%) were perceived as receiving futile treatment, and 11 (1%) were perceived as receiving futile treatment only on the day they transitioned to palliative care. (Palliative care is care designed to keep a dying patient as comfortable as possible.) The patients with futile treatment assessments received 464 days of treatment perceived to be futile in critical care (range: 1-58 days), accounting for 6.7% of all assessed patient days in the five ICUs studied. The majority (84) of the 123 patients perceived as receiving futile treatment died before hospital discharge and another 20 died within 6 months of ICU care (6-month mortality rate: 85%), with survivors remaining in severely compromised health states. The cost of futile treatment in critical care was estimated at $2.6 million.
The authors concluded that in one health system, treatment in critical care that is perceived to be futile is common and the cost is substantial.