Are Clinicians Providing Less Inappropriate Critical Care Than Five Years Ago?

Few medical centers have studied potentially inappropriate ICU treatment as much as UCLA. In their latest publication (in Journal of Critical Care) researchers report that "over five years the proportion of patients perceived to be receiving inappropriate critical care dropped by 40%." 

Among the top reasons treatment was judged inappropriate were:

• Treatment unable to achieve patient's goal
• Burdens of treatment outweigh benefits
• Patient unable to survive outside the ICU
• Patient permanently unconscious
• Patient imminently dying

Notably, PIT is not "futile" treatment. 27% of patients getting PIT survived to discharge. 15% were alive 6 months later. Still, prolonged biological survival in any state at any any cost is rarely a patient's goal.

Understanding the reasons for the change might elucidate how to continue to reduce inappropriate critical care. Apart from reducing moral distress and honoring patient preferences, the average cost for a day of PIT in the ICU is $7500.