What to Do About 'Futile' Critical Care


(The Health Care Blog)

physicians with critical care patient

by Neil S. Wenger

September 13, 2013

Thanks to extraordinary advances in medicine, critical care providers can save lives even when the cards are stacked against their patients. However, there are times when no amount of care, however cutting-edge it is, will save a patient. In these instances, when physicians recognize that patients will not be rescued, further critical care is said to be “futile.” In a new study, my RAND and UCLA colleagues and I find that critical care therapies that physicians regard as “futile” are not uncommon in intensive care units, raising some uncomfortable questions.

Of course, we're fortunate to have such fantastic technology at our disposal — but we must address how to use it appropriately when the patient may not benefit from high-intensity measures. When aggressive critical care is unsuccessful at achieving an acceptable level of health for the patient, treatment should focus on palliative care.

In our study, my colleagues and I quantified the prevalence and cost of “futile” critical care in the journal JAMA Internal Medicine. This can be seen as the first step toward reevaluating the status quo and better optimizing care for critical care patients.

After convening a group of critical care clinicians to determine a consensus definition of “futile treatment,” our research team analyzed nearly 7,000 daily assessments of more than 1,000 patients.

We found that 11 percent received futile treatment, while an additional 9 percent received “probably futile” treatment.

So physician-perceived futile critical care is indeed prevalent. But what about the cost?

The average cost of a day of “futile” treatment was roughly $4,000. For the 123 patients in our study deemed to have received futile treatment, this amounted to $2.6 million over three months. On average, that's more than $21,000 per patient. While this was only 3.5 percent of hospital costs for all the patients we studied, the cost is not insignificant.

These findings raise issues about whether physicians and patients and their families are communicating well enough for all to be on the same page, which is critical to timely, patient-centered decision making. Furthermore, the data might make one wonder whether healthcare resources are always well targeted to achieve the benefits that highly technical care aims to attain.

In the future, we hope to examine the full range of factors that might be contributing to the prevalence and cost of “futile” critical care. This is a complex issue, and we've only taken the first step toward refocusing treatment to better serve patients.

Neil Wenger, M.D., is the director of the Assessing Care of Vulnerable Elders (ACOVE) project at the non-profit, non-partisan RAND Corporation and a professor of medicine at the University of California, Los Angeles.

This commentary originally appeared on The Health Care Blog on September 16, 2013. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.