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

Research output: Contribution to journalArticle

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
JournalCritical Care Medicine
Early online date9 Aug 2019
DOIs
Publication statusE-pub ahead of print - 9 Aug 2019

Fingerprint

Patient Admission
Intensive Care Units
Consultants
Critical Care
Decision Making
Logistic Models
Observation
Interviews
Morbidity

Keywords

  • decision-making
  • intensive care admissions
  • intensive care triage
  • choice experiment

Cite this

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

U.K. Intensivists’ Preferences for Patient Admission to ICU : Evidence from a Choice Experiment. / Bassford, Christopher R (Corresponding Author); Krucien, Nicolas; Ryan, Mandy; Griffiths, Frances E; Svantesson-Sandberg, Mia ; Fritz, Zoe; Perkins, Gavin; Quinton, Sarah; Slowther, Anne-Marie .

In: Critical Care Medicine, 09.08.2019.

Research output: Contribution to journalArticle

Bassford, CR, Krucien, N, Ryan, M, Griffiths, FE, 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. https://doi.org/10.1097/CCM.0000000000003903
Bassford, Christopher R ; Krucien, Nicolas ; Ryan, Mandy ; Griffiths, Frances E ; Svantesson-Sandberg, Mia ; Fritz, Zoe ; Perkins, Gavin ; Quinton, Sarah ; Slowther, Anne-Marie . / U.K. Intensivists’ Preferences for Patient Admission to ICU : Evidence from a Choice Experiment. In: Critical Care Medicine. 2019.
@article{03f3f50e5f834f3a9064ff808abd4768,
title = "U.K. Intensivists’ Preferences for Patient Admission to ICU: Evidence from a Choice Experiment",
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.",
keywords = "decision-making, intensive care admissions, intensive care triage, choice experiment",
author = "Bassford, {Christopher R} and Nicolas Krucien and Mandy Ryan and Griffiths, {Frances E} and Mia Svantesson-Sandberg and Zoe Fritz and Gavin Perkins and Sarah Quinton and Anne-Marie Slowther",
note = "Conflicts of interest and sources of funding This article presents independent research funded by the National Institute for Health Research (NIHR) under the Health Services and Delivery Research Programme (Ref.13/10/14). The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Further information available at: www.journalslibrary.nihr.ac.uk/programmes/hsdr/131014 The University of Aberdeen (UoA) and the Chief Scientist Office (CSO) of the Scottish Government Health and Social Care Directorates fund the Health Economics Research Unit (HERU). Dr Zoe Fritz is funded by grants from Wellcome Professor Gavin Perkins, Professor Frances Griffiths and Dr Anne Slowther have received research grants from NIHR. Prof. Perkins is also supported by the NIHR as a senior investigator. Dr Anne Slowther’s spouse is a Director of Clinvivo The research team acknowledges the support of the National Institute of Health Research Clinical Research Network (NIHR CRN)",
year = "2019",
month = "8",
day = "9",
doi = "10.1097/CCM.0000000000003903",
language = "English",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - U.K. Intensivists’ Preferences for Patient Admission to ICU

T2 - Evidence from a Choice Experiment

AU - Bassford, Christopher R

AU - Krucien, Nicolas

AU - Ryan, Mandy

AU - Griffiths, Frances E

AU - Svantesson-Sandberg, Mia

AU - Fritz, Zoe

AU - Perkins, Gavin

AU - Quinton, Sarah

AU - Slowther, Anne-Marie

N1 - Conflicts of interest and sources of funding This article presents independent research funded by the National Institute for Health Research (NIHR) under the Health Services and Delivery Research Programme (Ref.13/10/14). The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Further information available at: www.journalslibrary.nihr.ac.uk/programmes/hsdr/131014 The University of Aberdeen (UoA) and the Chief Scientist Office (CSO) of the Scottish Government Health and Social Care Directorates fund the Health Economics Research Unit (HERU). Dr Zoe Fritz is funded by grants from Wellcome Professor Gavin Perkins, Professor Frances Griffiths and Dr Anne Slowther have received research grants from NIHR. Prof. Perkins is also supported by the NIHR as a senior investigator. Dr Anne Slowther’s spouse is a Director of Clinvivo The research team acknowledges the support of the National Institute of Health Research Clinical Research Network (NIHR CRN)

PY - 2019/8/9

Y1 - 2019/8/9

N2 - 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.

AB - 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.

KW - decision-making

KW - intensive care admissions

KW - intensive care triage

KW - choice experiment

UR - http://www.mendeley.com/research/uk-intensivists-preferences-patient-admission-icu

U2 - 10.1097/CCM.0000000000003903

DO - 10.1097/CCM.0000000000003903

M3 - Article

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

ER -