A Prospective Determination of the Incidence of Perceived Inappropriate Care in Critically Ill Patients

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dc.contributor.authorSingal, Rohit K
dc.contributor.authorSibbald, Robert
dc.contributor.authorMorgan, Brenda
dc.contributor.authorQuinlan, Mel
dc.contributor.authorParry, Neil
dc.contributor.authorRadford, Michael
dc.contributor.authorMartin, Claudio M
dc.date.accessioned2016-06-07T17:46:31Z
dc.date.available2016-06-07T17:46:31Z
dc.date.issued2014-1-1
dc.date.updated2016-06-07T06:53:00Z
dc.description.abstractBACKGROUND: Health care providers’ perceptions regarding appropriateness in end-of-life treatments have been widely studied. While nurses and physicians believe that rationing and other cost-related practices sometimes occur in the intensive care unit (ICU), they allege that treatment is often excessive.OBJECTIVE: To prospectively determine the incidence and causes of health care providers’ perceptions regarding appropriateness of end-of-life treatments.METHODS: The present prospective study collected data from patients admitted to the medical-surgical trauma ICU of a 30-bed, Canadian teaching hospital over a three-month period. Daily surveys were completed independently by bedside nurses, charge nurses and attending physician.RESULTS: In total, 5224 of 6558 expected surveys (representing 294 patients) were analyzed, yielding a response rate of 79.7%. The incidence of perceived inappropriate care in the present study was 6.5% (19 of 294 patients), with ongoing treatment for >2 days after this determination occurring in 1% (three of 294 patients). However, at least one caregiver perceived inappropriate care at some point in 110 of 294 (37.5%) patients. In these cases, in which processes to address care were not already underway, respondents believed that important issues resulting in provision of inappropriate treatments included patient-family issues and communication before or in the ICU. Caregivers did not know their patients’ wishes 22% (1129 of 5224) of the time.CONCLUSIONS: Although ongoing inappropriate care appeared to be a rare occurrence, the issue was a concern to at least one caregiver in one-third of cases. Public awareness for end-of-life issues, adequate communication, and up-to-date knowledge and practice in determining the wishes of critically ill patients are potential target areas to improve end-of-life care and reduce inappropriate care in the ICU. A daily, prospective survey of multidisciplinary caregivers, such as the survey used in the present study, is a viable and valuable means of determining the scope and causes of inappropriate care in the ICU.
dc.description.versionPeer Reviewed
dc.identifier.citationRohit K Singal, Robert Sibbald, Brenda Morgan, et al., “A Prospective Determination of the Incidence of Perceived Inappropriate Care in Critically Ill Patients,” Canadian Respiratory Journal, vol. 21, no. 3, pp. 165-170, 2014. doi:10.1155/2014/429789
dc.identifier.urihttp://dx.doi.org/10.1155/2014/429789
dc.identifier.urihttp://hdl.handle.net/1993/31336
dc.language.rfc3066en
dc.rightsopen accessen_US
dc.rights.holderCopyright © 2014 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
dc.titleA Prospective Determination of the Incidence of Perceived Inappropriate Care in Critically Ill Patients
dc.typeJournal Article
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