TY - JOUR
T1 - The prediction and cost of futility in the NICU
AU - Meadow, William
AU - Cohen-Cutler, Sally
AU - Spelke, Bridget
AU - Kim, Anna
AU - Plesac, Melissa
AU - Weis, Kirsten
AU - Lagatta, Joanne
PY - 2012/4
Y1 - 2012/4
N2 - Aim: To quantify the cost and prediction of futile care in the Neonatal Intensive Care Unit (NICU). Methods: We observed 1813 infants on 100 000 NICU bed days between 1999 and 2008 at the University of Chicago. We determined costs and assessed predictions of futility for each day the infant required mechanical ventilation. Results: Only 6% of NICU expenses were spent on nonsurvivors, and in this sense, they were futile. If only money spent after predictions of death is considered, futile expenses fell to 4.5%. NICU care was preferentially directed to survivors for even the smallest infants, at the highest risk to die. Over 75% of ventilated NICU infants were correctly predicted to survive on every day of ventilation by every caretaker. However, predictions of 'die before discharge' were wrong more than one time in three. Attendings and neonatology fellows tended to be optimistic, while nurses and neonatal nurse practitioners tended to be pessimistic. Conclusions: Criticisms of the expense of NICU care find little support in these data. Rather, NICU care is remarkably well targeted to patients who will survive, particularly when contrasted with care in adult ICUs. We continue to search for better prognostic tools for individual infants.
AB - Aim: To quantify the cost and prediction of futile care in the Neonatal Intensive Care Unit (NICU). Methods: We observed 1813 infants on 100 000 NICU bed days between 1999 and 2008 at the University of Chicago. We determined costs and assessed predictions of futility for each day the infant required mechanical ventilation. Results: Only 6% of NICU expenses were spent on nonsurvivors, and in this sense, they were futile. If only money spent after predictions of death is considered, futile expenses fell to 4.5%. NICU care was preferentially directed to survivors for even the smallest infants, at the highest risk to die. Over 75% of ventilated NICU infants were correctly predicted to survive on every day of ventilation by every caretaker. However, predictions of 'die before discharge' were wrong more than one time in three. Attendings and neonatology fellows tended to be optimistic, while nurses and neonatal nurse practitioners tended to be pessimistic. Conclusions: Criticisms of the expense of NICU care find little support in these data. Rather, NICU care is remarkably well targeted to patients who will survive, particularly when contrasted with care in adult ICUs. We continue to search for better prognostic tools for individual infants.
KW - Futility
KW - NICU economics
KW - neonatal outcomes research
KW - prediction
KW - prematurity
UR - http://www.scopus.com/inward/record.url?scp=84858078145&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84858078145&partnerID=8YFLogxK
U2 - 10.1111/j.1651-2227.2011.02555.x
DO - 10.1111/j.1651-2227.2011.02555.x
M3 - Article
C2 - 22150563
AN - SCOPUS:84858078145
SN - 0803-5253
VL - 101
SP - 397
EP - 402
JO - Acta Paediatrica, International Journal of Paediatrics
JF - Acta Paediatrica, International Journal of Paediatrics
IS - 4
ER -