TY - JOUR
T1 - The influence of access to a private attending physician on the withdrawal of life-sustaining therapies in the intensive care unit
AU - Kollef, Marin H.
AU - Ward, Suzanne
PY - 1999
Y1 - 1999
N2 - Objective: To assess the influence of patient access to a private attending physician on the withdrawal of life-sustaining therapies in a medical intensive care unit (ICU). Design: Prospective cohort study. Setting: A university-affiliated teaching hospital. Patients: A total of 501 consecutive patients admitted to the medical ICU during a 5-month period. Interventions: None. Measurements and Main Results: Among patients dying in the medical ICU, those without a private attending physician (n = 26) were statistically more likely to undergo the active withdrawal of life-sustaining therapies than patients with a private attending physician (n = 87) (80.8% vs. 29.9%; relative risk = 2.70; 95% confidence interval = 1.86-3.92; p < .001). Despite having similar predicted mortality rates by Acute Physiology and Chronic Health Evaluation II score (60.5% ± 27.0% vs. 66.1% ± 21.3%; p = .280), patients dying in the medical ICU without a private attending physician had statistically shorter hospital and ICU lengths of stay, a shorter duration of mechanical ventilation, and fewer total hospital costs and charges compared with patients with access to a private attending physician. Multiple logistic regression analysis, controlling for severity of illness, demographic characteristics, and patient diagnoses, demonstrated that lack of access to a private attending physician (adjusted odds ratio = 23.10; 95% confidence interval = 9.10-58.57; p < .001) and the presence of a do-not-resuscitate order while in the ICU (adjusted odds ratio = 7.33; 95% confidence interval = 3.6914.54; p = .004) were the only variables independently associated with the withdrawal of life-sustaining therapies before death. Conclusions: Patients dying in a medical ICU setting without access to a private attending physician are more likely to undergo the active withdrawal of life-sustaining therapies before death than patients with a private attending physician. Health care providers should be aware of possible variations in the practice of withdrawal of life-sustaining therapies in their ICUs based on this patient characteristic.
AB - Objective: To assess the influence of patient access to a private attending physician on the withdrawal of life-sustaining therapies in a medical intensive care unit (ICU). Design: Prospective cohort study. Setting: A university-affiliated teaching hospital. Patients: A total of 501 consecutive patients admitted to the medical ICU during a 5-month period. Interventions: None. Measurements and Main Results: Among patients dying in the medical ICU, those without a private attending physician (n = 26) were statistically more likely to undergo the active withdrawal of life-sustaining therapies than patients with a private attending physician (n = 87) (80.8% vs. 29.9%; relative risk = 2.70; 95% confidence interval = 1.86-3.92; p < .001). Despite having similar predicted mortality rates by Acute Physiology and Chronic Health Evaluation II score (60.5% ± 27.0% vs. 66.1% ± 21.3%; p = .280), patients dying in the medical ICU without a private attending physician had statistically shorter hospital and ICU lengths of stay, a shorter duration of mechanical ventilation, and fewer total hospital costs and charges compared with patients with access to a private attending physician. Multiple logistic regression analysis, controlling for severity of illness, demographic characteristics, and patient diagnoses, demonstrated that lack of access to a private attending physician (adjusted odds ratio = 23.10; 95% confidence interval = 9.10-58.57; p < .001) and the presence of a do-not-resuscitate order while in the ICU (adjusted odds ratio = 7.33; 95% confidence interval = 3.6914.54; p = .004) were the only variables independently associated with the withdrawal of life-sustaining therapies before death. Conclusions: Patients dying in a medical ICU setting without access to a private attending physician are more likely to undergo the active withdrawal of life-sustaining therapies before death than patients with a private attending physician. Health care providers should be aware of possible variations in the practice of withdrawal of life-sustaining therapies in their ICUs based on this patient characteristic.
KW - Critical care
KW - Health insurance
KW - Intensive care unit
KW - Private attending physician
KW - Withdrawal of life support
UR - http://www.scopus.com/inward/record.url?scp=0032751309&partnerID=8YFLogxK
U2 - 10.1097/00003246-199910000-00008
DO - 10.1097/00003246-199910000-00008
M3 - Article
C2 - 10548193
AN - SCOPUS:0032751309
SN - 0090-3493
VL - 27
SP - 2125
EP - 2132
JO - Critical care medicine
JF - Critical care medicine
IS - 10
ER -