Reducing Futile Care in the ICU Using Early Multidisciplinary Family Meetings

Abstract

PURPOSE: Many patients who die in the ICU often recieve prolonged invasive intensive care prior to death. This "futile" care is uncomfortable, costly, and potentially harmful and has no effect on the ultimate outcome. Reducing the risk of these futile therapies remains challenging. METHODS: To reduce futile care through improved decision-making, we conducted multidisciplinary family meetings for patients at high risk of death early after ICU admission. These structured meetings discussed the patient's clinical condition and prognosis, family's goals and expectations, and patient's advance directives and helped develop a plan-of-care for the patient's ICU stay. RESULTS: Over a 6 month period, we increased the proportion of family meetings for patients who eventually died from 27% to 60%, compared to a historic "control" group with decendents of similiar severity of illness. The proportion of decedents who were DNR status prior to death increased from 85% to 98%. Using hospital length of stay as a marker for potential futile care, we decreased hospital length of stay for each patient from a mean of 10.6 to 8.3 days, all of which were in the ICU before death. CONCLUSION: Multidisciplinary family meetings early in a critically ill patient's ICU stay can reduce the risk of using futile therapies prior to death. CLINICAL IMPLICATIONS: Reducing futile care through shared decision-making and improved communication with patients' families supports patient-centered care, reduces unnecessary costs, and improves quality of care at the end of life. We recommend early multidisciplinary family meetings be part of standard care in the ICU for patients at high risk of death.