Thanh H Neville1, Joshua F Wiley2, Miramar Kardouh3, J Randall Curtis4, Myrtle C Yamamoto5, Neil S Wenger6. 1. UCLA, Department of Medicine, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, USA. Electronic address: tneville@mednet.ucla.edu. 2. Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Australia. 3. UCLA, Department of Medicine, David Geffen School of Medicine, USA. 4. Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, USA. 5. UCLA, Department of Medicine, Quality Improvement, David Geffen School of Medicine, USA. 6. UCLA, Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, USA.
Abstract
PURPOSE: Intensive care interventions that prolong life without achieving meaningful benefit are considered clinically "inappropriate". In 2012, the frequency of perceived-inappropriate critical care was 10.8% at one academic health system; and we aimed to re-evaluate this frequency. METHODS: For 4 months in 2017, we surveyed critical care physicians daily and asked whether each patient was receiving appropriate, probably inappropriate, or inappropriate critical care. Patients were categorized into three groups: 1) patients for whom treatment was never inappropriate, 2) patients with at least one assessment that treatment was probably inappropriate, but no inappropriate treatment assessments, and 3) patients who had at least one assessment of inappropriate treatment. RESULTS: Fifty-five physicians made 10,105 assessments on 1424 patients. Of these, 94 (6.6%) patients received at least one assessment of inappropriate critical care, which is lower than 2012 (10.8% (p < 0.01)). Comparing 2017 and 2012, patient age, MS-DRG, length of stay, and hospital mortality were not significantly different (p > 0.05). Inpatient mortality in 2017 was 73% for patients receiving inappropriate critical care. CONCLUSIONS: Over five years the proportion of patients perceived to be receiving inappropriate critical care dropped by 40%. Understanding the reasons for such change might elucidate how to continue to reduce inappropriate critical care.
PURPOSE: Intensive care interventions that prolong life without achieving meaningful benefit are considered clinically "inappropriate". In 2012, the frequency of perceived-inappropriate critical care was 10.8% at one academic health system; and we aimed to re-evaluate this frequency. METHODS: For 4 months in 2017, we surveyed critical care physicians daily and asked whether each patient was receiving appropriate, probably inappropriate, or inappropriate critical care. Patients were categorized into three groups: 1) patients for whom treatment was never inappropriate, 2) patients with at least one assessment that treatment was probably inappropriate, but no inappropriate treatment assessments, and 3) patients who had at least one assessment of inappropriate treatment. RESULTS: Fifty-five physicians made 10,105 assessments on 1424 patients. Of these, 94 (6.6%) patients received at least one assessment of inappropriate critical care, which is lower than 2012 (10.8% (p < 0.01)). Comparing 2017 and 2012, patient age, MS-DRG, length of stay, and hospital mortality were not significantly different (p > 0.05). Inpatient mortality in 2017 was 73% for patients receiving inappropriate critical care. CONCLUSIONS: Over five years the proportion of patients perceived to be receiving inappropriate critical care dropped by 40%. Understanding the reasons for such change might elucidate how to continue to reduce inappropriate critical care.
Authors: Ruth D Piers; Elie Azoulay; Bara Ricou; Freda Dekeyser Ganz; Johan Decruyenaere; Adeline Max; Andrej Michalsen; Paulo Azevedo Maia; Radoslaw Owczuk; Francesca Rubulotta; Pieter Depuydt; Anne-Pascale Meert; Anna K Reyners; Andrew Aquilina; Maarten Bekaert; Nele J Van den Noortgate; Wim J Schrauwen; Dominique D Benoit Journal: JAMA Date: 2011-12-28 Impact factor: 56.272
Authors: Charles L Sprung; Bara Ricou; Christiane S Hartog; Paulo Maia; Spyros D Mentzelopoulos; Manfred Weiss; Phillip D Levin; Laura Galarza; Veronica de la Guardia; Joerg C Schefold; Mario Baras; Gavin M Joynt; Hans-Henrik Bülow; Georgios Nakos; Vladimir Cerny; Stephan Marsch; Armand R Girbes; Catherine Ingels; Orsolya Miskolci; Didier Ledoux; Sudakshina Mullick; Maria G Bocci; Jakob Gjedsted; Belén Estébanez; Joseph L Nates; Olivier Lesieur; Roshni Sreedharan; Alberto M Giannini; Lucía Cachafeiro Fuciños; Christopher M Danbury; Andrej Michalsen; Ivo W Soliman; Angel Estella; Alexander Avidan Journal: JAMA Date: 2019-11-05 Impact factor: 56.272
Authors: Carol Hodgson; Rinaldo Bellomo; Susan Berney; Michael Bailey; Heidi Buhr; Linda Denehy; Megan Harrold; Alisa Higgins; Jeff Presneill; Manoj Saxena; Elizabeth Skinner; Paul Young; Steven Webb Journal: Crit Care Date: 2015-02-26 Impact factor: 9.097