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Decision-making and outcomes of prolonged ICU stays in seriously ill patients.
J Am Geriatr Soc. 2000 05; 48(S1):S70-4.JA

Abstract

BACKGROUND

Despite concern about the high costs and the uncertain benefit of prolonged treatment in the intensive care unit (ICU), there has been little research examining decision-making and outcomes for patients with prolonged ICU stays.

OBJECTIVES

To evaluate decision-making and outcomes for seriously ill patients with an ICU stay of at least 14 days.

DESIGN

A prospective cohort study.

SETTING

Five teaching hospitals.

PARTICIPANTS

Seriously ill patients enrolled in the Study To Understand Prognoses and Preferences for Risks and Outcomes of Treatments (SUPPORT).

MEASUREMENT

Patients, their surrogate decision-makers, and their physicians were interviewed about prognosis, communication, and goals of medical care. Based on age, diagnoses, comorbid illnesses, and acute physiology data, the SUPPORT Prognostic Model provided estimates of 6-month survival on study days 1, 3, 7, and 14. Hospital costs were estimated from hospital billing data.

RESULTS

Of the 9105 patients enrolled in SUPPORT, 1494 (16%) had ICU stays of 14 days or longer. The median length of stay in an ICU was 4 days for the entire SUPPORT cohort and 35 days for patients who were treated in an ICU for 14 days or longer. Median hospital costs were $76,501 for patients who had ICU stays 14 days or longer and $10,916 for patients who did not have long ICU stays. Fifty-five percent of patients with long ICU stays had died by 6 months, and an additional 19% had substantial functional impairment. Among patients with ICU stays of at least 14 days, only 20% had estimates of 6-month survival that fell below 10% at any time during their hospitalization. For patients with long ICU stays, the mean predicted probability of 6-month survival was 0.46 on study Day 3 and 0.47 on study Day 14. Fewer than 40% of patients (or their surrogates) reported that their physicians had talked with them about their prognoses or preferences for life-sustaining treatment. Among the patients who preferred a palliative approach to care, only 29% thought that their care was consistent with that aim. Those who discussed their preferences for care with a physician were 1.9 times more likely to believe that treatment was in accord with their preferences for palliation (95% CI, 1.4-2.5)

CONCLUSIONS

Prolonged ICU stays were expensive and were often followed by death or disability. Patients reported low rates of discussions with their physicians about their prognoses and preferences for life-sustaining treatments. Many preferred that care focus on palliation and believed that care was inconsistent with their preferences. Patients were more likely to receive care consistent with their preferences if they had discussed their care preferences with their physicians.

Authors+Show Affiliations

Center For Gerontology and Health Care Research, Brown University, Providence, Rhode Island 02912, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

10809459

Citation

Teno, J M., et al. "Decision-making and Outcomes of Prolonged ICU Stays in Seriously Ill Patients." Journal of the American Geriatrics Society, vol. 48, no. S1, 2000, pp. S70-4.
Teno JM, Fisher E, Hamel MB, et al. Decision-making and outcomes of prolonged ICU stays in seriously ill patients. J Am Geriatr Soc. 2000;48(S1):S70-4.
Teno, J. M., Fisher, E., Hamel, M. B., Wu, A. W., Murphy, D. J., Wenger, N. S., Lynn, J., & Harrell, F. E. (2000). Decision-making and outcomes of prolonged ICU stays in seriously ill patients. Journal of the American Geriatrics Society, 48(S1), S70-4.
Teno JM, et al. Decision-making and Outcomes of Prolonged ICU Stays in Seriously Ill Patients. J Am Geriatr Soc. 2000;48(S1):S70-4. PubMed PMID: 10809459.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Decision-making and outcomes of prolonged ICU stays in seriously ill patients. AU - Teno,J M, AU - Fisher,E, AU - Hamel,M B, AU - Wu,A W, AU - Murphy,D J, AU - Wenger,N S, AU - Lynn,J, AU - Harrell,F E,Jr PY - 2000/5/16/pubmed PY - 2000/6/8/medline PY - 2000/5/16/entrez KW - Death and Euthanasia KW - Empirical Approach KW - Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) SP - S70 EP - 4 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 48 IS - S1 N2 - BACKGROUND: Despite concern about the high costs and the uncertain benefit of prolonged treatment in the intensive care unit (ICU), there has been little research examining decision-making and outcomes for patients with prolonged ICU stays. OBJECTIVES: To evaluate decision-making and outcomes for seriously ill patients with an ICU stay of at least 14 days. DESIGN: A prospective cohort study. SETTING: Five teaching hospitals. PARTICIPANTS: Seriously ill patients enrolled in the Study To Understand Prognoses and Preferences for Risks and Outcomes of Treatments (SUPPORT). MEASUREMENT: Patients, their surrogate decision-makers, and their physicians were interviewed about prognosis, communication, and goals of medical care. Based on age, diagnoses, comorbid illnesses, and acute physiology data, the SUPPORT Prognostic Model provided estimates of 6-month survival on study days 1, 3, 7, and 14. Hospital costs were estimated from hospital billing data. RESULTS: Of the 9105 patients enrolled in SUPPORT, 1494 (16%) had ICU stays of 14 days or longer. The median length of stay in an ICU was 4 days for the entire SUPPORT cohort and 35 days for patients who were treated in an ICU for 14 days or longer. Median hospital costs were $76,501 for patients who had ICU stays 14 days or longer and $10,916 for patients who did not have long ICU stays. Fifty-five percent of patients with long ICU stays had died by 6 months, and an additional 19% had substantial functional impairment. Among patients with ICU stays of at least 14 days, only 20% had estimates of 6-month survival that fell below 10% at any time during their hospitalization. For patients with long ICU stays, the mean predicted probability of 6-month survival was 0.46 on study Day 3 and 0.47 on study Day 14. Fewer than 40% of patients (or their surrogates) reported that their physicians had talked with them about their prognoses or preferences for life-sustaining treatment. Among the patients who preferred a palliative approach to care, only 29% thought that their care was consistent with that aim. Those who discussed their preferences for care with a physician were 1.9 times more likely to believe that treatment was in accord with their preferences for palliation (95% CI, 1.4-2.5) CONCLUSIONS: Prolonged ICU stays were expensive and were often followed by death or disability. Patients reported low rates of discussions with their physicians about their prognoses and preferences for life-sustaining treatments. Many preferred that care focus on palliation and believed that care was inconsistent with their preferences. Patients were more likely to receive care consistent with their preferences if they had discussed their care preferences with their physicians. SN - 0002-8614 UR - https://www.unboundmedicine.com/medline/citation/10809459/Decision_making_and_outcomes_of_prolonged_ICU_stays_in_seriously_ill_patients_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0002-8614&date=2000&volume=48&issue=S1&spage=S70 DB - PRIME DP - Unbound Medicine ER -