U.K. Intensivists' Preferences for Patient Admission to ICU: Evidence From a Choice Experiment.
Bassford, Christopher R
Perkins, Gavin D
Critical care medicine
Lippincott Williams & Wilkins Ltd.
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Bassford, C. R., Krucien, N., Ryan, M., Griffiths, F. E., Svantesson, M., Fritz, Z., Perkins, G. D., et al. (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
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.
Humans, Patient Admission, Severity of Illness Index, Attitude of Health Personnel, Professional-Family Relations, Age Factors, Comorbidity, Adult, Middle Aged, Medical Staff, Hospital, Intensive Care Units, Triage, Female, Male, Surveys and Questionnaires, Clinical Decision-Making, United Kingdom
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
Wellcome Trust (208213/Z/17/Z)
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External DOI: https://doi.org/10.1097/ccm.0000000000003903
This record's URL: https://www.repository.cam.ac.uk/handle/1810/293274
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