Resource utilisation and description of patients perceived as receiving inappropriate critical care

Abstract

ObjectiveMedical interventions that do not offer the patient meaningful benefit due to inconsistency with prognoses are often considered “inappropriate” by clinicians. We described the clinical details and resource utilisation of patients who were assessed as receiving inappropriate treatment. DesignChart abstraction was performed on 123 patients who were assessed by their critical care physician as having received inappropriate treatment to document clinical characteristics, diagnostic testing, life-sustaining treatments and nursing assessments of daily pain and level of consciousness. ResultsThe mean age was 67 and on admission, 41% had cancer and 25% had advanced pulmonary disease. At least one of the following three conditions was noted in 57% of the patients: severe neurological injury, overwhelming sepsis or irreversible respiratory failure. Patients were less likely to be alert (OR 0.39, CI 0.16–0.91, p = 0.03) on days they were assessed as receiving inappropriate critical care. After they were assessed as receiving inappropriate critical care, they received 172 imaging studies, 151 procedures, 522 days of mechanical ventilation (excludes one patient who received 1020 days of mechanical ventilation), 254 days of vasopressors, 226 days of hemodialysis and 10 attempts at cardiopulmonary resuscitation. ConclusionsPatients assessed as receiving inappropriate critical care receive resource-intensive medical care, largely while non-alert.