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.