CRJ Canadian Respiratory Journal 1198-2241 Pulsus Group Inc 429789 10.1155/2014/429789 Original Article A Prospective Determination of the Incidence of Perceived Inappropriate Care in Critically Ill Patients Singal Rohit K 1 Sibbald Robert 2 Morgan Brenda 2 Quinlan Mel 2 Parry Neil 2 3 Radford Michael 2 3 Martin Claudio M cmartin1@uwo.ca 2 3 1 Faculty of Medicine Department of Surgery University of Manitoba Winnipeg Manitoba Canada umanitoba.ca 2 London Health Sciences Centre Schulich School of Medicine and Dentistry Western University London Ontario Canada uwo.ca 3 Division of Critical Care Schulich School of Medicine and Dentistry Western University London Ontario Canada uwo.ca 2014 21 3 165 170 2014 Copyright © 2014 Hindawi Publishing Corporation. This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes.

BACKGROUND: Health care providers’ perceptions regarding appropriateness in end-of-life treatments have been widely studied. While nurses and physicians believe that rationing and other cost-related practices sometimes occur in the intensive care unit (ICU), they allege that treatment is often excessive.

OBJECTIVE: To prospectively determine the incidence and causes of health care providers’ perceptions regarding appropriateness of end-of-life treatments.

METHODS: The present prospective study collected data from patients admitted to the medical-surgical trauma ICU of a 30-bed, Canadian teaching hospital over a three-month period. Daily surveys were completed independently by bedside nurses, charge nurses and attending physician.

RESULTS: In total, 5224 of 6558 expected surveys (representing 294 patients) were analyzed, yielding a response rate of 79.7%. The incidence of perceived inappropriate care in the present study was 6.5% (19 of 294 patients), with ongoing treatment for >2 days after this determination occurring in 1% (three of 294 patients). However, at least one caregiver perceived inappropriate care at some point in 110 of 294 (37.5%) patients. In these cases, in which processes to address care were not already underway, respondents believed that important issues resulting in provision of inappropriate treatments included patient-family issues and communication before or in the ICU. Caregivers did not know their patients’ wishes 22% (1129 of 5224) of the time.

CONCLUSIONS: Although ongoing inappropriate care appeared to be a rare occurrence, the issue was a concern to at least one caregiver in one-third of cases. Public awareness for end-of-life issues, adequate communication, and up-to-date knowledge and practice in determining the wishes of critically ill patients are potential target areas to improve end-of-life care and reduce inappropriate care in the ICU. A daily, prospective survey of multidisciplinary caregivers, such as the survey used in the present study, is a viable and valuable means of determining the scope and causes of inappropriate care in the ICU.

 End of life Futility ICU Inappropriate treatment