title: The frequency and cost of treatment perceived to be futile in critical care.
abstract: OBJECTIVE
  Physicians often perceive as futile intensive care interventions that prolong life without achieving an effect that the patient can appreciate as a benefit. The prevalence and cost of critical care perceived to be futile have not been prospectively quantified.
  
  
  OBJECTIVE
  To quantify the prevalence and cost of treatment perceived to be futile in adult critical care.
  
  
  METHODS
  To develop a common definition of futile care, we convened a focus group of clinicians who care for critically ill patients. On a daily basis for 3 months, we surveyed critical care specialists in 5 intensive care units (ICUs) at an academic health care system to identify patients whom the physicians believed were receiving futile treatment. Using a multivariate model, we identified patient and clinician characteristics associated with patients perceived to be receiving futile treatment. We estimated the total cost of futile treatment by summing the charges of each day of receiving perceived futile treatment and converting to costs.
  
  
  METHODS
  Prevalence of patients perceived to be receiving futile treatment.
  
  
  RESULTS
  During a 3-month period, there were 6916 assessments by 36 critical care specialists of 1136 patients. Of these patients, 904 (80%) were never perceived to be receiving futile treatment, 98 (8.6%) were perceived as receiving probably futile treatment, 123 (11%) were perceived as receiving futile treatment, and 11 (1%) were perceived as receiving futile treatment only on the day they transitioned to palliative care. The patients with futile treatment assessments received 464 days of treatment perceived to be futile in critical care (range, 1-58 days), accounting for 6.7% of all assessed patient days in the 5 ICUs studied. Eighty-four of the 123 patients perceived as receiving futile treatment died before hospital discharge and 20 within 6 months of ICU care (6-month mortality rate of 85%), with survivors remaining in severely compromised health states. The cost of futile treatment in critical care was estimated at $2.6 million.
  
  
  CONCLUSIONS
  In 1 health system, treatment in critical care that is perceived to be futile is common and the cost is substantial.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles.
authors.forename: Thanh N
authors.initials: TN
authors.lastname: Huynh
authors.forename: Eric C
authors.initials: EC
authors.lastname: Kleerup
authors.forename: Joshua F
authors.initials: JF
authors.lastname: Wiley
authors.forename: Terrance D
authors.initials: TD
authors.lastname: Savitsky
authors.forename: Diana
authors.initials: D
authors.lastname: Guse
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Garber
authors.forename: Neil S
authors.initials: NS
authors.lastname: Wenger
mesh_terms: D001291:Attitude of Health Personnel; D003422:Critical Care / Q000191:economics / Q000523:psychology / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D018447:Medical Futility / Q000523:psychology*; D008875:Middle Aged; D011446:Prospective Studies