Approach to Medical Futility in a Community Hospital: Is Use of a Prognostic Scoring System Applicable?

Abstract

All acute care medical facilities and healthcare providers are faced with cases of medical futility. Guidance must ensure the initiation of communication with the patient or family regarding end of life planning. Identification of certain physiological features may provide impetus for such communication. In an effort to identify the physiological variables that may trigger discussion in a futile medical treatment policy, the application of a prognostic scoring system is examined. The Acute Physiology and Chronic Health Evaluation Score (APACHE II) system, a widely applied set of acute, chronic and diagnostic variables, is identified through literature review. This paper examines the applicability of the prognostic scoring system APACHE II in a rural, community intensive care unit. Data from internal systems identified a pool from which a sample of medical records were selected and retrospectively reviewed. Records for all patients who expired and a representative number of those discharged to home are selected, comprising 23% of the original pool of 300 patients. Data abstracted from these records was entered into a web enabled APACHE II scoring program. Resultant scores along with length of stay (LOS) and demographic data were analyzed to examine the accuracy of mortality prediction. Although study design proved to be limited and multiple opportunities for improvement can be noted, clearly identifiable parameters of mortality were evident. In spite of study design flaws it was recommended that a prognostic system such as APACHE II be adopted in the ICU as a routine part of each patient admission.