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Futility and inappropriate care in pediatric intensive care: a cross-sectional survey
Gopi Vemuri1, Stephen Derek Playfor
1Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Pendlebury, Manchester, UK.
Insights
Pediatric intensive care units (PICUs) in the UK face challenges with futile and inappropriate admissions. A survey found 21% of care was deemed inappropriate or futile, highlighting a need for standardized approaches.
Area of Science:
- Pediatric critical care medicine
- Healthcare management
- Quality improvement in healthcare
Background:
- Growing concerns about non-beneficial admissions to UK pediatric intensive care units (PICUs).
- Need to assess the extent and characteristics of potentially futile or inappropriate care.
- Understanding patient demographics and conditions associated with these admissions.
Purpose of the Study:
- To survey UK PICUs regarding admissions deemed inappropriate or futile.
- To identify patient characteristics and reasons for admission in such cases.
- To inform strategies for improving care appropriateness in PICUs.
Main Methods:
- Prospective cross-sectional survey of all UK PICUs.
- Data collection via mail using standardized forms.
- Inclusion of patient demographics, admission reasons, comorbidities, and clinician-assessed care appropriateness (appropriate, futile, inappropriate).
Main Results:
- Responses from 21 UK PICUs (68% response rate) detailing 111 patients.
- 8% of care deemed futile, 13% inappropriate (total 21% non-appropriate).
- Futile/inappropriate admissions commonly involved respiratory failure and pre-existing conditions like developmental delay or cardiovascular disease.
Conclusions:
- A significant proportion (21%) of UK PICU care was assessed as futile or inappropriate by unit directors.
- Urgent need to quantify resource use in these cases.
- Establishment of standardized protocols for managing futility and inappropriate care in PICUs is critical.
Background:
Over recent years, there have been increasing concerns regarding an increase in the number of futile and inappropriate admissions to pediatric intensive care units (PICUs) in the United Kingdom (UK).
Methods:
A prospective cross-sectional survey was carried out using a data collection form distributed by mail to the directors of all PICUs in the UK. Respondents were asked to give details of all patients on their unit on a specific day including age, reason for admission and any preexisting medical conditions. An assessment was made by respondents of whether the care being provided in each case was, in their opinion, appropriate, futile or inappropriate according to standard definitions.
Results:
We received responses from 21 units (68%) who reported the details of 111 patients. Care was felt to be appropriate in 88 of these cases (79%), futile in nine cases (8%) and inappropriate in 14 cases (13%). Futile cases were most commonly admitted with respiratory failure and all had preexisting medical conditions, most commonly developmental delay. Where care was felt to be inappropriate, respiratory failure was again the most common reason for admission and all had a preexisting medical condition, most commonly cardiovascular disease.
Conclusions:
The care being provided in 21% of the PICU cases, described in this study, was felt to be either futile or inappropriate by the directors of those units. There is an urgent need to, accurately, establish the resource consumption associated with these patients and to establish a standard approach to futility and inappropriate care in PICU in the UK.