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    Rights statement: The final, definitive version of this article has been published in the Journal, Journal of the Intensive Care Society, ? (?), 2018, © SAGE Publications Ltd, 2018 by SAGE Publications Ltd at the Journal of the Intensive Care Society page: http://journals.sagepub.com/home/inc on SAGE Journals Online: http://journals.sagepub.com/

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Intensive care decision-making: Identifying the challenges and generating solutions to improve inter-specialty referrals to critical care

Research output: Contribution to journalJournal article

E-pub ahead of print
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<mark>Journal publication date</mark>19/02/2018
<mark>Journal</mark>Journal of the Intensive Care Society
Number of pages12
StateE-pub ahead of print
Early online date19/02/18
Original languageEnglish

Abstract

Introduction
Decision-making regarding admission to UK intensive care units is challenging. Demand for beds exceeds capacity, yet the need to provide emergency cover creates pressure to build redundancy into the system. Guidelines to aid clinical decision-making are outdated, resulting in an over-reliance on professional judgement. Although clinicians are highly skilled, there is variability in intensive care unit decision-making, especially at the inter-specialty level wherein cognitive biases contribute to disagreement.

Method
This research is the first to explore intensive care unit referral and admission decision-making using the Critical Decision Method interviewing technique. We interviewed intensive care unit (n = 9) and non-intensive care unit (n = 6) consultants about a challenging referral they had dealt with in the past where there was disagreement about the patient’s suitability for intensive care unit.

Results
We present: (i) a description of the referral pathway; (ii) challenges that appear to derail referrals (i.e. process issues, decision biases, inherent stressors, post-decision consequences) and (iii) potential solutions to improve this process.

Discussion
This research provides a foundation upon which interventions to improve inter-specialty decision-making can be based.

Bibliographic note

The final, definitive version of this article has been published in the Journal, Journal of the Intensive Care Society, ? (?), 2018, © SAGE Publications Ltd, 2018 by SAGE Publications Ltd at the Journal of the Intensive Care Society page: http://journals.sagepub.com/home/inc on SAGE Journals Online: http://journals.sagepub.com/