Decision-making in ICU - A systematic review of factors considered important by ICU clinician decision makers with regard to ICU triage decisions.

Abstract:

BACKGROUND:The ICU is a scarce resource within a high-stress, high-stakes, time-sensitive environment where critically ill patients with life-threatening conditions receive expensive life-sustaining care under the guidance of expert qualified personnel. The implications of decisions such as suitability for admission into ICU are potentially dire and difficult. OBJECTIVES:To conduct a systematic review of clinicians' subjective perceptions of factors that influence the decision to accept or refuse patients referred to ICU. RESULTS:Twenty studies yielded 56 different factors classified into patient, physician and environmental. Common, important factors were: acute illness severity and reversibility; presence and severity of comorbidities; patient age, functional status, state-of-mind and wishes; physician level of experience and perception of patient QOL; and bed availability. Within-group variability among physicians and thought-deed discordance were demonstrated. CONCLUSIONS:The complex and dynamic ICU triage decision is affected by numerous interacting factors. The literature provides some indication of these factors, but fail to show complexities and interactions between them. A decision tree is proposed. Further research should include a reflection on how decisions for admission to ICU are made, such that a better understanding of these processes can be achieved allowing for improved individual and group consistency.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Gopalan PD,Pershad S

doi

10.1016/j.jcrc.2018.11.027

subject

Has Abstract

pub_date

2019-04-01 00:00:00

pages

99-110

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(18)31420-5

journal_volume

50

pub_type

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