Working in an ICU, a common factor relating to rising health care costs that is often discussed is the idea of futile care.  Patients in the ICU setting often receive care that cannot and will not resolve their medical problems and undergo treatment plans that will not improve or prolong their life expectancy. The idea of futile care is not new. When third-party insurance payments for medical care began to rise, people adopted the mentality that if they are not responsible for the costs, then everything must be done (Paris & Hawkins, 2015). This attitude and the shift towards the need to please the consumer has been detrimental to the increase in rising health care costs (Paris & Hawkins, 2015).

Patients and their families are not the only blame in futile care. It is noted that approximately $700 billion accounts for wasteful spending in healthcare per year and 87% of that spending is directed by physicians (Tartaglia, Kman, & Ledford, 2015). Doctors, specifically medical students and residents are not appropriately taught cost-conscious approaches in handling potential end of life cases (Tartaglia et al., 2015). An increase in unnecessary diagnostic testing was shown in educational environments versus non-teaching environments (Tartaglia et al., 2015).  While residents are in the hospital to learn, the cycle of teaching them without regard for cost should be broken.

As a nurse leader, communication would be the most effective approach to facilitating a change in unnecessary spending in futile cases. While I could not change doctors’ orders, I could advocate for consultation with the palliate care team. Encouraging and mentoring nurses to communicate with doctors about palliative care in a respectful manner could promote a decrease in unnecessary testing and wasteful spending. Care should always be about what is best for the patient and encouraging the use of palliative care would support both this ideal and business.

References

Paris, J. J., & Hawkins, A. (2015). Futility is a failed concept in medical decision making: Its use should be abandoned. The American Journal of Bioethics, 15(7), 50-52. doi:10.1080/15265161.2015.1039735

Tartaglia, K. M., Kman, N., & Ledford, C. (2015). Medical student perceptions of cost-conscious care in an internal medicine clerkship: A thematic analysis. Journal of General Internal Medicine, 30(10), 1491-1496. doi:10.1007/s11606-015-3324-4