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U.K. Intensivists' Preferences for Patient Admission to ICU: Evidence From a Choice Experiment.

Accepted version
Peer-reviewed

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Type

Article

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Authors

Bassford, Christopher R 
Krucien, Nicolas 
Ryan, Mandy 
Griffiths, Frances E 
Svantesson, Mia 

Abstract

OBJECTIVES: Deciding whether to admit a patient to the ICU requires considering several clinical and nonclinical 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 prioritize 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. Senior intensive care doctors (consultants) were presented with pairs of patient profiles and asked to prioritize 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: Online survey across U.K. intensive care. SUBJECTS: Intensive care consultants working in NHS hospitals. MEASUREMENTS AND MAIN RESULTS: Of the factors investigated, patient's age had the largest impact at admission followed by the views of their family, and severity of their main comorbidity. Physiologic 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. CONCLUSIONS: ICU consultants vary in the importance they give to different factors in deciding who to prioritize for ICU admission. Transparency regarding which factors have been considered in the decision-making process could reduce variability and potential inequity for patients.

Description

Keywords

Adult, Age Factors, Attitude of Health Personnel, Clinical Decision-Making, Comorbidity, Female, Humans, Intensive Care Units, Male, Medical Staff, Hospital, Middle Aged, Patient Admission, Professional-Family Relations, Severity of Illness Index, Surveys and Questionnaires, Triage, United Kingdom

Journal Title

Crit Care Med

Conference Name

Journal ISSN

0090-3493
1530-0293

Volume Title

47

Publisher

Ovid Technologies (Wolters Kluwer Health)

Rights

All rights reserved
Sponsorship
Wellcome Trust (208213/Z/17/Z)
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