Cost of Futile ICU Care in One Ontario Hospital
Critical care is a costly and finite resource that provides the ability to manage patients with life-threatening illnesses in the most advanced forms available. However, not every condition benefits from critical care. There are unrecoverable health states in which it should not be used to perpetuat...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2021-07-01
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| Series: | Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| Online Access: | https://doi.org/10.1177/00469580211028577 |
| _version_ | 1818652470387146752 |
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| author | Nicholas Schouela MD Kwadwo Kyeremanteng MD, MHA Laura H. Thompson MSc, PhD David Neilipovitz MD Michel Shamy MD, MA Gianni D’Egidio MD, MEng |
| author_facet | Nicholas Schouela MD Kwadwo Kyeremanteng MD, MHA Laura H. Thompson MSc, PhD David Neilipovitz MD Michel Shamy MD, MA Gianni D’Egidio MD, MEng |
| author_sort | Nicholas Schouela MD |
| collection | DOAJ |
| description | Critical care is a costly and finite resource that provides the ability to manage patients with life-threatening illnesses in the most advanced forms available. However, not every condition benefits from critical care. There are unrecoverable health states in which it should not be used to perpetuate. Such situations are considered futile. The determination of medical futility remains controversial. In this study we describe the length of stay (LOS), cost, and long-term outcomes of 12 cases considered futile and that have been or were considered for adjudication by Ontario’s Consent and Capacity Board (CBB). A chart review was undertaken to identify patients admitted to the Intensive Care Unit (ICU), whose care was deemed futile and cases were considered for, or brought before the CCB. Costs for each of these admissions were determined using the case-costing system of The Ottawa Hospital Data Warehouse. All 12 patients identified had a LOS of greater than 4 months (range: 122-704 days) and a median age 83.5 years. Seven patients died in hospital, while 5 were transferred to long term or acute care facilities. All patients ultimately died without returning to independent living situations. The total cost of care for these 12 patients was $7 897 557.85 (mean: $658 129.82). There is a significant economic cost of providing resource-intensive critical care to patients in which these treatments are considered futile. Clinicians should carefully consider the allocation of finite critical care resources in order to utilize them in a way that most benefits patients. |
| first_indexed | 2024-12-17T02:22:31Z |
| format | Article |
| id | doaj.art-4982f9a3c1534b3aaa0a2225549504a7 |
| institution | Directory Open Access Journal |
| issn | 0046-9580 1945-7243 |
| language | English |
| last_indexed | 2024-12-17T02:22:31Z |
| publishDate | 2021-07-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| spelling | doaj.art-4982f9a3c1534b3aaa0a2225549504a72022-12-21T22:07:13ZengSAGE PublishingInquiry: The Journal of Health Care Organization, Provision, and Financing0046-95801945-72432021-07-015810.1177/00469580211028577Cost of Futile ICU Care in One Ontario HospitalNicholas Schouela MD0Kwadwo Kyeremanteng MD, MHA1Laura H. Thompson MSc, PhD2David Neilipovitz MD3Michel Shamy MD, MA4Gianni D’Egidio MD, MEng5University of Ottawa, Ottawa, ON, CanadaUniversity of Ottawa, Ottawa, ON, CanadaOttawa Hospital Research Institute, Ottawa, ON, CanadaUniversity of Ottawa, Ottawa, ON, CanadaOttawa Hospital Research Institute, Ottawa, ON, CanadaUniversity of Ottawa, Ottawa, ON, CanadaCritical care is a costly and finite resource that provides the ability to manage patients with life-threatening illnesses in the most advanced forms available. However, not every condition benefits from critical care. There are unrecoverable health states in which it should not be used to perpetuate. Such situations are considered futile. The determination of medical futility remains controversial. In this study we describe the length of stay (LOS), cost, and long-term outcomes of 12 cases considered futile and that have been or were considered for adjudication by Ontario’s Consent and Capacity Board (CBB). A chart review was undertaken to identify patients admitted to the Intensive Care Unit (ICU), whose care was deemed futile and cases were considered for, or brought before the CCB. Costs for each of these admissions were determined using the case-costing system of The Ottawa Hospital Data Warehouse. All 12 patients identified had a LOS of greater than 4 months (range: 122-704 days) and a median age 83.5 years. Seven patients died in hospital, while 5 were transferred to long term or acute care facilities. All patients ultimately died without returning to independent living situations. The total cost of care for these 12 patients was $7 897 557.85 (mean: $658 129.82). There is a significant economic cost of providing resource-intensive critical care to patients in which these treatments are considered futile. Clinicians should carefully consider the allocation of finite critical care resources in order to utilize them in a way that most benefits patients.https://doi.org/10.1177/00469580211028577 |
| spellingShingle | Nicholas Schouela MD Kwadwo Kyeremanteng MD, MHA Laura H. Thompson MSc, PhD David Neilipovitz MD Michel Shamy MD, MA Gianni D’Egidio MD, MEng Cost of Futile ICU Care in One Ontario Hospital Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| title | Cost of Futile ICU Care in One Ontario Hospital |
| title_full | Cost of Futile ICU Care in One Ontario Hospital |
| title_fullStr | Cost of Futile ICU Care in One Ontario Hospital |
| title_full_unstemmed | Cost of Futile ICU Care in One Ontario Hospital |
| title_short | Cost of Futile ICU Care in One Ontario Hospital |
| title_sort | cost of futile icu care in one ontario hospital |
| url | https://doi.org/10.1177/00469580211028577 |
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