The High Costs of Non-Beneficial Treatment in the ICU
There's another new study out on what could be losely termed inappropriate ICU adminssions. This study explores end-of-life care and the differences between continued non-beneficial treatment and comfort care. What the study authors call “ethics consultation” is really palliative care. The results were dramatic:
The reduction in costs among patients assigned to the ethics consultation versus usual care was consistent across hospitals, although the study was not powered to detect site-specific effects. Five of the six sites saw reductions in costs ranging from $2,276 to $5,573 person. In one site with greatly decreased lengths-of-stay in the intervention group, costs were reduced almost $40,000 ($81,162 versus $41,269). Study participants at this site had a higher proportion of long-term and complicated chronic disease. This site also had the fewest study participants and thus did not disproportionately affect the estimated differential in cost between the intervention and control groups, $5,246. The average differential across sites, allowing each site an equal weight, was $9,914.
Since ICUs are common patient flow bottlenecks, moving terminally ill patients to lower acuity units where they can receive palliative care is not only best for the patient (who would chose to spend their last days gorked out in an ICU?), but can improve patient flow – a benefit not considered in this study. I'm surprised more hospitals do not provide paliative care, given the low implementation cost and obvious benefits.
