Admission to intensive care: A qualitative study of triage and its determinants.
Adult
Attitude of Health Personnel
Comorbidity
Decision Making
Female
Health Care Rationing
/ organization & administration
Humans
Intensive Care Units
/ organization & administration
Interviews as Topic
Male
Middle Aged
Patient Acuity
Patient Admission
Patient Preference
Physicians
/ psychology
Qualitative Research
Switzerland
Tertiary Care Centers
/ organization & administration
Triage
/ organization & administration
Intensive care
code status
decision making
end-of-life care
triage
Journal
Health services research
ISSN: 1475-6773
Titre abrégé: Health Serv Res
Pays: United States
ID NLM: 0053006
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
pubmed:
27
10
2018
medline:
30
1
2020
entrez:
27
10
2018
Statut:
ppublish
Résumé
To examine physicians' decision making and its determinants about admission to intensive care. ICU physicians (n = 12) and internists (n = 12) working in a Swiss tertiary care hospital. We conducted in-depth interviews. Interviews were analyzed using an inductive thematic approach. Admission decisions regarding seriously ill or elderly patients with comorbidities are complex. Nonmedical factors such as ICU beds availability, health care resources on the ward, information about patient preferences, and family behavior determine the decision. Code status and the quality of interaction between physicians are key determinants. The absence of code status or poor documentation of code status discussions makes decisions more difficult and laden emotionally, as physicians feel they are making a life-death decision. Mutual respect and collaborative decision making facilitate the decision. Tensions arise due to ICU physicians' postponing the decision because of lack of beds, ICU physicians' dismissive attitudes, perceived shortcomings in the other physician's completion of expected tasks, and preconceptions about the other physician. Systematic documentation of code status, and fostering collaboration between ICU physicians and internists would facilitate ICU admission decisions in complex clinical situations.
Identifiants
pubmed: 30362106
doi: 10.1111/1475-6773.13076
pmc: PMC6407353
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
474-483Subventions
Organisme : Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
ID : 139304
Pays : International
Informations de copyright
© Health Research and Educational Trust.
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