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Ethics consultations can reduce nonbeneficial treatments and costs among dying patients

Conflicts often arise within a family, among health care providers, or between providers and the family, about the use of aggressive life-sustaining treatment among adult patients in intensive care units (ICUs) who ultimately do not survive to hospital discharge. Ethics consultations can help redirect the focus of treatment from aggressive and futile efforts at prolonging life to permitting a comfortable, dignified death, explains Lawrence J. Schneiderman, M.D., of the University of California, San Diego. In the process, ethics consultations can also reduce hospital days and treatment costs among these patients, concludes a study supported by the Agency for Healthcare Research and Quality (HS10251).

Dr. Schneiderman and his colleagues estimated the costs of nonbeneficial treatment (life-prolonging treatment for patients who do not survive to hospital discharge) using results from a randomized trial of ethics consultations at six hospitals with busy ICUs and active ethics consultation services. The study randomized about 500 patients with conflicts about care to either an ethics consultation or usual care (consultation not offered).

Among patients who survived to hospital discharge, there was no difference in length of stay (LOS) or costs between the two groups. However, among patients who failed to survive to hospital discharge, patients in the ethics consultation intervention group had a shorter LOS than the control group (an average of 8 days vs. 11 days, respectively). The intervention group also had lower hospital costs with an average of $24,938 compared to $30,184 for patients in the control group.

Five of the six hospitals saw reductions in costs related to ethics consultations ranging from $2,276 to $5,573 per patient. The researchers estimated that an ethics consultation practice would reduce treatment costs in a hospital with 40 ICU beds by $157,380. More than 90 percent of nurses and physicians and 80 percent of patients or their surrogates said they would seek ethics consultations again and recommend them to others.

See "The costs of nonbeneficial treatment in the intensive care setting," by Todd Gilmer, Ph.D., Dr. Schneiderman, Holly Teetzel, M.A., and others, in the July 2005 Health Affairs 24(4), pp. 961-971.

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