U.K. Intensivists’ Preferences for Patient Admission to ICU: Evidence from a Choice Experiment

Christopher R Bassford (Corresponding Author), Nicolas Krucien, Mandy Ryan, Frances E Griffiths, Mia Svantesson-Sandberg, Zoe Fritz, Gavin Perkins, Sarah Quinton, Anne-Marie Slowther

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Abstract

Objective: Deciding whether to admit a patient to the intensive care unit (ICU) requires considering several clinical and non-clinical factors. Studies have investigated factors associated with the decision but have not explored the relative importance of different factors, nor the interaction between factors on decision-making. We examined how ICU consultants prioritise specific factors when deciding whether to admit a patient to ICU.
Design: Informed by a literature review and data from observation and interviews with ICU clinicians we designed a choice experiment (CE). Senior intensive care doctors (consultants) were presented with pairs of patient profiles and asked to prioritise one of the patients in each task for admission to ICU. A multinomial logit and a latent class logit model was used for the data analyses.
Setting: On-line survey across UK intensive care.
Participants: Intensive care consultants working in NHS hospitals.
Results: Of the factors investigated, patient's age had the largest impact on admission followed by the views of their family, and severity of their main co-morbidity. Physiological measures indicating severity of illness had less impact than the gestalt assessment by the ICU registrar. We identified four distinct decision-making patterns, defined by the relative importance given to different factors.
Conclusion: ICU consultants vary in the importance they give to different factors in deciding who to prioritise for ICU admission. Transparency regarding which factors have been considered in the decision-making process could reduce variability and potential inequity for patients.
Original languageEnglish
Pages (from-to)1522-1530
Number of pages9
JournalCritical Care Medicine
Volume47
Issue number11
Early online date9 Aug 2019
DOIs
Publication statusPublished - Nov 2019

Keywords

  • decision-making
  • intensive care admissions
  • intensive care triage
  • choice experiment
  • obstructive pulmonary-disease
  • refusal
  • care-unit
  • determinants
  • outcomes
  • triage decisions
  • of-life
  • REFUSAL
  • DETERMINANTS
  • TRIAGE DECISIONS
  • OF-LIFE
  • OBSTRUCTIVE PULMONARY-DISEASE
  • CARE-UNIT
  • OUTCOMES

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  • Cite this

    Bassford, C. R., Krucien, N., Ryan, M., Griffiths, F. E., Svantesson-Sandberg, M., Fritz, Z., Perkins, G., Quinton, S., & Slowther, A-M. (2019). U.K. Intensivists’ Preferences for Patient Admission to ICU: Evidence from a Choice Experiment. Critical Care Medicine, 47(11), 1522-1530. https://doi.org/10.1097/CCM.0000000000003903