Understanding irresponsible use of intensive care unit resources in the USA

George L Anesi; Andrew J Admon; Scott D Halpern; Meeta P Kerlin

doi:10.1016/S2213-2600(19)30088-8

Understanding irresponsible use of intensive care unit resources in the USA

Lancet Respir Med. 2019 Jul;7(7):605-612. doi: 10.1016/S2213-2600(19)30088-8. Epub 2019 May 20.

Authors

George L Anesi¹, Andrew J Admon², Scott D Halpern³, Meeta P Kerlin⁴

Affiliations

¹ Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: george.anesi@uphs.upenn.edu.
² Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA.
³ Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA, USA; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA; Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.

PMID: 31122898
DOI: 10.1016/S2213-2600(19)30088-8

Abstract

Use of intensive care unit (ICU) resources in the USA far outpaces that of other countries. This increased use is not accompanied by superior clinical outcomes and is at times discordant with patient desires. This Series paper seeks to identify major drivers of ICU resource use in the USA, and to offer steps towards better aligning ICU resource use with clinical needs and patient preferences. After considering several factors, such as organisational, ethical, and economic factors, we suggest that there are four intersecting drivers of irresponsible use of ICU resources in the USA: first, excess ICU bed capacity and a scarcity of data to understand which patients that truly benefit from ICU compared with ward care; second, clinicians misinterpreting the goals and means of patient autonomy; third, an extreme fear of rationing by the general public; and fourth, fee-for-service driven use of advanced medical technologies and procedures that beget ICU expansion.

Publication types

Review

MeSH terms

Critical Care / statistics & numerical data*
Facilities and Services Utilization
Health Resources / statistics & numerical data*
Humans
Patient Admission
Triage
United States