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Economic implications of end-of-life care in the ICU

Khandelwal, Nitaa; Curtis, J. Randallb

Current Opinion in Critical Care: December 2014 - Volume 20 - Issue 6 - p 656–661
doi: 10.1097/MCC.0000000000000147
ETHICAL, LEGAL AND ORGANIZATIONAL ISSUES IN THE ICU: Edited by Hannah Wunsch
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Purpose of review Advance care planning and palliative care interventions can improve the quality of end-of-life care by reducing unwanted high intensity care at the end of life. This may have important economic implications and may reduce the financial burden of patients’ families. We review the literature to examine the impact advance care planning and palliative care has on ICU utilization, specifically ICU admissions and ICU length of stay (LOS), and to provide insight into ways to reduce costs and financial burden of care while simultaneously improving quality of care.

Recent findings We identified three studies assessing the impact of palliative care consultation on ICU admissions for patients with life-limiting illness; all three demonstrate reduced ICU admissions for patients receiving palliative care consultation. Among 16 studies evaluating ICU LOS as an outcome, five report no change and 11 report decrease in LOS for patients receiving advance care planning or palliative care. These studies are heterogeneous in design and target population; however, a trend toward reduced ICU utilization exists.

Summary Advance care planning and palliative care can reduce ICU utilization at the end of life. The degree to which reducing ICU utilization decreases emotional and financial burden of end-of-life care for patients and families is unknown.

aDepartment of Anesthesiology and Pain Medicine

bDivision of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA

Correspondence to Nita Khandelwal, MD, MSc, Harborview Medical Center, 325 9th Avenue, Box 359724, Seattle, WA 98104, USA. Tel: +1 206 744 4371; fax: +1 206 744 8090; e-mail: khandel@uw.edu

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