Resource utilisation and description of patients perceived as receiving inappropriate critical care.
Thanh H Neville, Myrtle C Yamamoto, Joshua F Wiley and 1 others
PMID 31204107WHAT IT FOUND
Doctors judged 123 ICU patients to be receiving inappropriate care; 68% died before discharge, they received 1542 ventilator days, and on days judged inappropriate or probably inappropriate they were non-alert 62% of the time when pain and consciousness were assessed.
Key findings
01Of 1136 ICU patients, 123 were assessed as receiving inappropriate critical care, and 68% of those patients died before hospital discharge.
02On days when pain and level of consciousness were assessed, patients were non-alert for 382 of 620 days, and pain scores were not significantly different between inappropriate and appropriate care days.
03After being assessed as receiving inappropriate care, the 123 patients spent 1542 days on mechanical ventilation, 254 days on vasopressors, and 226 days on hemodialysis.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study came from one academic health system and included only 123 patients with detailed chart abstraction. Inappropriate critical care was defined by attending physicians, not by patients or families, and family meeting content was not known. The data were collected retrospectively from nurse chart records, which may be less precise or missing than research-collected data. Nurse-documented level of consciousness could not distinguish sedation from baseline neurological status. Detailed chart abstraction was not done for patients assessed as receiving appropriate care, so resource use and family meetings could not be compared with that group.
Declared interests
None of the authors declared conflicts of interest.
The easy way to misread this
Do not read this as proof that withdrawing or limiting life-sustaining treatment would improve outcomes. The study describes patients judged by physicians to be receiving inappropriate care, and it cannot separate the effects of prognosis, family preferences, sedation, and the treatments actually given.