Resource consumption and the extent of futile care among patients in a pediatric intensive care unit setting

• Published in: The Journal of pediatrics Vol. 128; no. 6; pp. 742 - 747
• Main Authors: Sachdeva, Ramesh C., Jefferson, Larry S., Coss-Bu, Jorge, Brody, Baruch A.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.06.1996; Elsevier
• Subjects: Adolescent; Bioethics; Biological and medical sciences; Child; Child, Preschool; Cohort Studies; Economy. Management; Female; Health and social institutions; Health Resources - economics; Hospital Mortality; Humans; Infant; Intensive Care Units, Pediatric - economics; Length of Stay - economics; Life Support Care - economics; Male; Medical Futility; Medical sciences; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Resource Allocation; Severity of Illness Index; Survival Analysis; Texas; Treatment Outcome; Texas; TISS; PCPC; PRISM; PICU; POPC; Human; Costs; Intensive care; Staff management; Hospital; Resource management; Child; Empirical Approach; Professional Patient Relationship; Health Care and Public Health
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(96)70323-2

OBJECTIVES: To estimate resource consumption and the extent of futile care among patients admitted to the pediatric intensive care unit (PICU). STUDY DESIGN: A prospective cohort study of 353 consecutive admissions followed for 1334 patient-days during the PICU stay at the Texas Children's Hospital in Houston, Texas. Participants were 353 children and adolescents who were hospitalized in the PICU during September and October 1993. Three broad operational definitions of futility were developed to capture the maximum extent of resource consumption related to medical futility. Definition 1 (imminent demise futility) was developed by an objective, validated, severity of illness measure (Pediatric Risk of Mortality Score) to identify patients with high mortality risks. Definition 2 (lethal condition futility) was used to identify patients in the PICU whose long-term survival was unlikely. Definition 3 (qualitative futility) was used to identify patients with high morbidity. Resource consumption was measured according to the number of patient-days in the PICU and the Therapeutic Intervention Scoring System. RESULTS: Twenty-three (6.5%) patients representing 36 (2.7%) patient-days met at least one of the definitions of medical futility for some of the days when they were in the PICU. None of the patient-days that met any of the definitions of medical futility were associated with high resource consumption compared with non-futile care patient-days. CONCLUSIONS: Despite our use of broad definitions of medical futility, relatively small amounts of resources were used in futile PICU care. This suggests that attempts to reduce resource consumption in the PICU by focusing on medical futility are unlikely to be successful. (J P EDIATR 1996;128:742-7)