ICU Variability in Decisions to Limit Life Sustaining Therapies

Yesterday, at the ATS, Caroline M. Quill, MD, a fellow in Penn's department of Pulmonary, Allergy, and Critical Care at Penn Medicine, presented (and here) "Variation Among ICUs In Decisions To Limit Life Sustaining Therapies."



Quill's team found substantial variation in decisions to forgo life-sustaining therapies rates among 153 ICUs in the United States.  This suggests that many factors unrelated to the patient or family may be affecting such decisions.  Patient factors such as severity of illness, age, race, and functional status explain a significant amount of the variability in decisions.  But ICU culture and physician practices also play a major role.  



Quill's study revealed a six-fold variation among ICUs in the probability of a decision to forgo life-sustaining therapy. This suggests that the ICU to which a given patient is admitted influences his or her odds of having a decision for stop life-sustaining treatment, regardless of personal or clinical characteristics.