TY - JOUR

T1 - An observational study of critical care physicians' assessment and decision-making practices in response to patient referrals

AU - Charlesworth, Michael

AU - Mort, Maggie

AU - Smith, Andrew F.

N1 - This is the peer reviewed version of the following article: Charlesworth, M., Mort, M. and Smith, A. F. (2017), An observational study of critical care physicians' assessment and decision-making practices in response to patient referrals. Anaesthesia, 72: 80–92. doi:10.1111/anae.13667 which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/anae.13667/abstract This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.

PY - 2017/1

Y1 - 2017/1

N2 - Previous studies of critical care admissions have largely compared patients that have been granted or declined admission. To better understand the decision process itself, our ethnographic approach combined observation of and interviews with critical care physicians in a large English hospital. We observed 30 critical care doctors managing 71 referrals and conducted ten interviews with senior decision-makers to explore the themes raised by our observations. We analysed data using the constant comparative method. We found that the decision to move a patient to critical care was just one way in which the trajectory of critical illness could be modified. When patients were admitted to critical care, it was not always for invasive monitoring or advanced organ support, with some admitted for more general medical and/or nursing care. When patients were declined admission, they were not simply forgotten or left behind; they nevertheless underwent careful assessment and follow-up. Thus, depicting admission or refusal as a binary event is misleading. We suggest that prescriptive admission algorithms are problematic for clinicians, in that they may not take into account the complexity of clinical practice.

AB - Previous studies of critical care admissions have largely compared patients that have been granted or declined admission. To better understand the decision process itself, our ethnographic approach combined observation of and interviews with critical care physicians in a large English hospital. We observed 30 critical care doctors managing 71 referrals and conducted ten interviews with senior decision-makers to explore the themes raised by our observations. We analysed data using the constant comparative method. We found that the decision to move a patient to critical care was just one way in which the trajectory of critical illness could be modified. When patients were admitted to critical care, it was not always for invasive monitoring or advanced organ support, with some admitted for more general medical and/or nursing care. When patients were declined admission, they were not simply forgotten or left behind; they nevertheless underwent careful assessment and follow-up. Thus, depicting admission or refusal as a binary event is misleading. We suggest that prescriptive admission algorithms are problematic for clinicians, in that they may not take into account the complexity of clinical practice.

KW - admitting department

KW - critical care

KW - decision-making

KW - ethnography

KW - hospital

U2 - 10.1111/anae.13667

DO - 10.1111/anae.13667

M3 - Journal article

C2 - 27714766

VL - 72

SP - 80

EP - 92

JO - Anaesthesia

JF - Anaesthesia

SN - 0003-2409

IS - 1

ER -