The cost of care in level one trauma centers, per average episode, was about $5,600 more than treatment provided by non-trauma hospitals, the researchers wrote. Reducing the number of patients who were treated in level one or level two trauma center, but did not need such intense care, would save about $136.7 million a year across the study's locations.
To achieve those savings, emergency medical service agencies must do more to comply with triage guidelines, the authors said. “This study highlights the importance of accurate field triage processes so that patients' needs can be matched with hospitals' capabilities and excess costs in trauma systems can be minimized.”
A second study, published online by the Journal of the American Medical Association Internal Medicine, sought to estimate the cost of critical care that physicians consider “futile.”
The cost for one health system totaled $2.6 million for three months, or an average of $4,000 a day.
The study authors acknowledged that criteria for futile treatment—in this case, derived from descriptions by 13 doctors—are subjective and patients' families may not agree with them.
For their purposes, researchers defined futile care in a half-dozen ways. One definition was care for which the burden was “grossly” greater than any benefit. It was the criterion most frequently cited by doctors who were surveyed for the study.
Treatment for patients unable to survive outside intensive care also was deemed futile, as was care to those who were permanently unconscious. Care for those about to die was considered futile. Researchers also included as futile care that was unable to achieve patients' goals. Finally, intensive care provided on the day patients were transferred to palliative care was also deemed futile.
The study used daily assessments by three dozen critical care clinicians of care provided to 1,136 patients over three months.
Nonetheless, clinicians continued to provide care they considered futile, the authors said. They admitted they didn't know why.
“Reasons might include lack of agreement by the family, lack of agreement within the clinical team, or a failure to address end-of-life issues,” they said. “We were unable to characterize the reasons that treatment perceived as futile was provided.”
In another article in the same journal, physicians from Harvard University and the University of Pittsburgh cautioned that the results should be interpreted with care.
Decisions about what care to provide patients at the end of life should be made collectively by doctors, patients, families and other providers, wrote Drs. Robert Troug of Harvard and Douglas White of the University of Pittsburgh. Patients are vulnerable and such decisions are complex. “Even within the medical profession, clinicians vary substantially in their attitudes and practices regarding what sorts of treatments should be provided near the end of life.”
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