Change in inappropriate critical care over time

Area of Science:

• Medical Ethics
• Critical Care Medicine
• Health Services Research

Background:

• Intensive care interventions prolonging life without meaningful benefit are deemed clinically inappropriate.
• A previous study in 2012 reported a 10.8% frequency of perceived inappropriate critical care.

Purpose of the Study:

• To re-evaluate the frequency of perceived inappropriate critical care in an academic health system.
• To assess changes in the utilization of potentially futile intensive care over time.

Main Methods:

• A daily survey of critical care physicians was conducted over four months in 2017.
• Physicians assessed patients' critical care as appropriate, probably inappropriate, or inappropriate.
• Patients were categorized based on the assessments received.

Main Results:

• Fifty-five physicians made 10,105 assessments on 1424 patients.
• 6.6% of patients received at least one assessment of inappropriate critical care, a decrease from 10.8% in 2012 (p < 0.01).
• Patient demographics and outcomes (age, MS-DRG, length of stay, hospital mortality) did not significantly differ between the study periods.

Conclusions:

• The proportion of patients receiving perceived inappropriate critical care dropped by 40% over five years.
• Understanding the drivers of this reduction can inform strategies to further decrease inappropriate critical care.
• Inpatient mortality remained high (73%) for patients receiving inappropriate critical care in 2017.