TY - JOUR
T1 - Change in inappropriate critical care over time
AU - Neville, Thanh H.
AU - Wiley, Joshua F.
AU - Kardouh, Miramar
AU - Curtis, J. Randall
AU - Yamamoto, Myrtle C.
AU - Wenger, Neil S.
PY - 2020/12
Y1 - 2020/12
N2 - 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.
AB - 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.
KW - Critical care
KW - Inappropriate treatment
KW - Intensive care unit
KW - Mortality
UR - http://www.scopus.com/inward/record.url?scp=85090581855&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2020.08.028
DO - 10.1016/j.jcrc.2020.08.028
M3 - Article
AN - SCOPUS:85090581855
SN - 0883-9441
VL - 60
SP - 267
EP - 272
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -