We want to move to development of practice habits that are similar enough so that we can make triage decisions, including those related to the operating rooms, transfers and essentially all patients with similar criteria. For instance, you can't have one service that never moves patients, even if a patient isn't critically ill, and go tell another service to move a gravely ill patient to a step-down unit. Our habits have to be similarly based in patient acuity so that we can make these kinds of decisions equitably. Futile care is not fair to the patient, even if the ICU is otherwise completely empty. Nevertheless, the issue is more topical if you need the bed and you look around the ICU and see patients receiving futile care.
Futile care can be a relative concept.
What may be futile care to you, Kathy, Norm and me may not be futile to someone equally reasonable. But this same issue arises for other groups as well. Some patients don't really need to be in the ICU and could be successfully cared for elsewhere, if we planned properly. Then there are other patients who could have been treated for a shorter period of time in the ICU if we had appropriate general protocols that applied to them. I think that we need to move to a form of care that's consensual enough so that all physicians can understand what other practitioners should be doing with the patient.