Providing futile care in the ICU prevents other patients from receiving critical care

http://www.eurekalert.org/pub_releases/2014-08/uoc--pfc081914.php

Providing futile treatment in the intensive care unit sets off a chain reaction that causes other ill patients needing medical attention to wait for critical care beds, according to a study by researchers from UCLA and RAND Health.

The study is the first to show that when unbeneficial medical care is provided, others who might be able to benefit from treatment are harmed, said study lead author Dr. Thanh Huynh, an assistant professor of medicine in the division of pulmonary and critical care medicine at the David Geffen School of Medicine at UCLA.

The findings also have implications for the fairness of the American healthcare system, and points toward needed policy improvements to more efficiently use limited healthcare resources, said senior author Dr. Neil S. Wenger, a UCLA professor of medicine, a RAND Health scientist and director of the UCLA Health Ethics Center at the David Geffen School of Medicine at UCLA.

"Many people do not realize that there is a tension between what medicine is able to do and what medicine should do. Even fewer realize that medicine is commonly used to achieve goals that most people, and perhaps most of society, would not value – such as prolonging the dying process in the intensive care unit when a patient cannot improve," Wenger said. "But almost no one recognizes that these actions affect other patients, who might receive delayed care or, worse, not receive needed care at all because futile medical treatment was provided to someone else."

The study appears in the August issue of the peer-reviewed journal Critical Care Medicine.

•••••

The study showed that on 16% of days when an ICU was full, it contained at least one patient receiving futile treatment. During those days, 33 patients were kept in the emergency department for more than four hours, nine patients waited more than one day to be transferred from an outside hospital and 15 patients canceled their transfer request after waiting more than one day. Two patients died at outside hospitals while waiting to be transferred into the academic medical center ICU.

•••••