Decision-making in intensive care medicine - A review

Journal of the Intensive Care Society
Fiona R JamesShondipon Laha

Abstract

Decision-making by intensivists around accepting patients to intensive care units is a complex area, with often high-stakes, difficult, emotive decisions being made with limited patient information, high uncertainty about outcomes and extreme pressure to make these decisions quickly. This is exacerbated by a lack of clear guidelines to help guide this difficult decision-making process, with the onus largely relying on clinical experience and judgement. In addition to uncertainty compounding decision-making at the individual clinical level, it is further complicated at the multi-speciality level for the senior doctors and surgeons referring to intensive care units. This is a systematic review of the existing literature about this decision-making process and the factors that help guide these decisions on both sides of the intensive care unit admission dilemma. We found many studies exist assessing the patient factors correlated with intensive care unit admission decisions. Analysing these together suggests that factors consistently found to be correlated with a decision to admit or refuse a patient from intensive care unit are bed availability, severity of illness, initial ward or team referred from, patient choice, do not resusc...Continue Reading

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Citations

Dec 10, 2019·Current Opinion in Supportive and Palliative Care·Massimo Romanò
Jan 19, 2020·Acta Anaesthesiologica Scandinavica·Alma Nordenskjöld SyrousLinda Block
Mar 24, 2021·Annales médico-psychologiques·Guillaume FondLaurent Boyer

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