Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
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DOI：
10.1007/s00134-023-07031-w
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发表时间：
2023-05
影响因子：
38.9
通讯作者：
Iwashyna, Theodore J. J.
中科院分区：
文献类型：
--
作者：
Valley, Thomas S. S.;Schutz, Amanda;Miller, Jacquelyn;Miles, Lewis;Lipman, Kyra;Eaton, Tammy L. L.;Kinni, Harish;Cooke, Colin R. R.;Iwashyna, Theodore J. J.
美国的一些医院使用的重症监护比其他医院多20倍。由于重症监护对某些人来说是救命的，但对其他人来说可能是有害的，因此有必要了解影响重症监护室（ICU）入院决定的因素。八家美国医院的定性分析进行了半结构化，一对一的访谈，辅以现场访问和临床观察。共有87名参与者（24名护士，52名医生和11名其他工作人员）进行了采访，并花了40小时观察ICU手术在8家医院。确定了四个医院层面的因素，影响ICU入院决策。首先，中间护理的可用性导致了可能被送往ICU的患者的重新分配。其次，与会者强调了ICU护士可用性的重要性，作为ICU能力的关键修改器。由经验丰富的普通护理医生和护士护理的患者不太可能接受ICU护理。第三，较小或农村医院选择更长的急诊科病人住院时间，而不是ICU入院时间，以加快危重病人的院内转移。第四，ICU入院政策缺乏明确性导致临床医生感到有压力使用ICU护理的病人，否则可能没有收到it. Health保健系统应该评估他们使用ICU护理，并建立制度模式，确保ICU入院的决定是以病人为中心，但也考虑到资源和限制，特别是每家医院。在线版本包含补充材料，可通过10.1007/s 00134 -023-07031-w获得。
Some hospitals in the United States (US) use intensive care 20 times more than others. Since intensive care is lifesaving for some but potentially harmful for others, there is a need to understand factors that influence how intensive care unit (ICU) admission decisions are made. A qualitative analysis of eight US hospitals was conducted with semi-structured, one-on-one interviews supplemented by site visits and clinical observations. A total of 87 participants (24 nurses, 52 physicians, and 11 other staff) were interviewed, and 40 h were spent observing ICU operations across the eight hospitals. Four hospital-level factors were identified that influenced ICU admission decision-making. First, availability of intermediate care led to reallocation of patients who might otherwise be sent to an ICU. Second, participants stressed the importance of ICU nurse availability as a key modifier of ICU capacity. Patients cared for by experienced general care physicians and nurses were less likely to receive ICU care. Third, smaller or rural hospitals opted for longer emergency department patient-stays over ICU admission to expedite interhospital transfer of critically ill patients. Fourth, lack of clarity in ICU admission policies led clinicians to feel pressured to use ICU care for patients who might otherwise not have received it. Health care systems should evaluate their use of ICU care and establish institutional patterns that ensure ICU admission decisions are patient-centered but also account for resources and constraints particular to each hospital. The online version contains supplementary material available at 10.1007/s00134-023-07031-w.
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