TY - JOUR

T1 - Intensive care decision-making

T2 - Identifying the challenges and generating solutions to improve inter-specialty referrals to critical care

AU - Power, Nicola

AU - Plummer, Nicholas R.

AU - Baldwin, Jacqueline

AU - James, Fiona R.

AU - Laha, Shondipon

N1 - The final, definitive version of this article has been published in the Journal, Journal of the Intensive Care Society, 19 (4), 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/

PY - 2018/11/1

Y1 - 2018/11/1

N2 - IntroductionDecision-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 Guidelines to aid clinical decision-making are outdated, resulting in an over-reliance on professional judgement.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.MethodThis 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.ResultsWe 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.DiscussionThis research provides a foundation upon which interventions to improve inter-specialty decision-making can be based.

AB - IntroductionDecision-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 Guidelines to aid clinical decision-making are outdated, resulting in an over-reliance on professional judgement.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.MethodThis 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.ResultsWe 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.DiscussionThis research provides a foundation upon which interventions to improve inter-specialty decision-making can be based.

KW - Intensive care

KW - decision-making

KW - critical decision method

KW - patient admission

KW - inter-speciality teams

U2 - 10.1177/1751143718758933

DO - 10.1177/1751143718758933

M3 - Journal article

VL - 19

SP - 287

EP - 298

JO - Journal of the Intensive Care Society

JF - Journal of the Intensive Care Society

SN - 1751-1437

IS - 4

ER -