ArticlePloS one2019
What are the characteristics that lead physicians to perceive an ICU stay as non-beneficial for the patient?
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- The role of timely assessment of appropriate care in reducing greenhouse gas emissions in intensive care medicine.Annals of intensive care · 2026Article
- End-of-life practices in 11 German intensive care units : Results from the ETHICUS-2 study.Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2023Article
- Causes and Outcomes of Intensive Care Admission Refusals: A Retrospective Audit from a Rural Teaching Hospital in Eastern Cape, South Africa.Clinics and practice · 2023Article
- Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients.Internal and emergency medicine · 2023Article
- Non-beneficial admission to the intensive care unit: A nationwide survey of practices.PloS one · 2023Article
- ICU stays that are judged to be non-beneficial: A qualitative study of the perception of nursing staff.PloS one · 2023Article
- Article
- Non-readmission decisions in the intensive care unit: A qualitative study of physicians' experience in a multicentre French study.PloS one · 2021Article
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Authors and funding
13 authors.
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Abstract
purposeWe sought to describe the characteristics that lead physicians to perceive a stay in the intensive care unit (ICU) as being non-beneficial for the patient. MATERIALS AND
methodsIn the first step, we used a multidisciplinary focus group to define the characteristics that lead physicians to consider a stay in the ICU as non-beneficial for the patient. In the second step, we assessed the proportion of admissions that would be perceived by the ICU physicians as non-beneficial for the patient according to our focus group's definition, in a large population of ICU admissions in 4 French ICUs over a period of 4 months.
resultsAmong 1075 patients admitted to participating ICUs during the study period, 155 stays were considered non-beneficial for the patient, yielding a frequency of 14.4% [95% confidence interval (CI) 8.9, 19.9]. Average age of these patients was 72 ±12.8 years. Mortality was 43.2% in-ICU [95%CI 35.4, 51.0], 55% [95%CI 47.2, 62.8] in-hospital. The criteria retained by the focus group to define a non-beneficial ICU stay were: patient refusal of ICU care (23.2% [95%CI 16.5, 29.8]), and referring physician's desire not to have the patient admitted (11.6% [95%CI 6.6, 16.6]). The characteristics that led physicians to perceive the stay as non-beneficial were: patient's age (36.8% [95%CI 29.2, 44.4]), unlikelihood of recovering autonomy (61.9% [95%CI 54.3, 69.6]), prior poor quality of life (60% [95%CI 52.3, 67.7]), terminal status of chronic disease (56.1% [95%CI 48.3, 63.9]), and all therapeutic options have been exhausted (35.5% [95%CI 27.9, 43.0]). Factors that explained admission to the ICU of patients whose stay was subsequently judged to be non-beneficial included: lack of knowledge of patient's wishes (52% [95%CI 44.1, 59.9]); decisional incapacity (sedation) (69.7% [95%CI 62.5, 76.9]); inability to contact family (34% [95%CI 26.5, 41.5]); pressure to admit (from family or other physicians) (50.3% [95%CI 42.4, 58.2]).
conclusionsNon-beneficial ICU stays are frequent. ICU admissions need to be anticipated, so that patients who would yield greater benefit from other care pathways can be correctly oriented in a timely manner.
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