Decision making in interhospital transport of critically ill patients: national questionnaire survey among critical care physicians

Abstract

Objective: This study assessed the relative importance of clinical and transport-related factors in physicians' decision-making regarding the interhospital transport of critically ill patients. Methods:The medical heads of all 95 ICUs in The Netherlands were surveyed with a questionnaire using 16 case vignettes to evaluate preferences for transportability; 78 physicians (82%) participated. The vignettes varied in eight factors with regard to severity of illness and transport conditions. Their relative weights were calculated for each level of the factors by conjoint analysis and expressed in β. The reference value (β = 0) was defined as the optimal conditions for critical care transport; a negative β indicated preference against transportability. Results: The type of escorting personnel (paramedic only: β = -3.1) and transport facilities (standard ambulance β = -1.21) had the greatest negative effect on preference for transportability. Determinants reflecting severity of illness were of relative minor importance (dose of noradrenaline β = -0.6, arterial oxygenation β = -0.8, level of peep β = -0.6). Age, cardiac arrhythmia, and the indication for transport had no significant effect. Conclusions: Escorting personnel and transport facilities in interhospital transport were considered as most important by intensive care physicians in determining transportability. When these factors are optimal, even severely critically ill patients are considered able to undergo transport. Further clinical research should tailor transport conditions to optimize the use of expensive resources in those inevitable road trips.

Clinical Factors and the Decision to Transfuse Chronic Dialysis Patients

“…Conjoint analysis has been used in evaluating clinical decision-making in depression (31), rheumatology (32), spinal surgery (33), diabetes management (34), and interhospital transport of critically ill patients (35,36). Recently, conjoint analysis was used to understand patient preferences for HIV medications (37).…”

Skubi Medicinos Pagalba: Tarphospitaliniai Pervežimai

“…Mokslininkų nuomone, specialios ligonių pervežimo specialistų komandos turėtų pagerinti kritiškai sunkių pacientų būklę ir sumažinti ankstyvą mirtingumą (Ligtenberg et al, 2005, p. 449;Wong, Levy, 2005, p. 293;Kue et al, 2011, p. 159). Nurodoma, kad specializuotos pervežimų komandos ir tinkama įranga sumažina padidėjusią riziką transportuojant (Oakley, 1999, p. 61;Lieshout et al, 2008Lieshout et al, , p. 1269Kue et al, 2011, p. 159). Ten, kur dirba patyrę darbuotojai, prieš transportavimą atliekamų intervencijų kokybė dažnai geresnė už mažiau įgūdžių turinčiųjų teikiamą pagalbą.…”

“…Todėl nuo 2004 m. nemažai ne tretinio lygio paslaugas teikiančių gydymo įstaigų sukūrė skubios medicinos pagalbos personalo grandį priėmimo skyriuose, tai galėjo lemti mirties rizikos sumažėjimą tarphospitalinių pervežimų metu (Gillman et al, 2013, p. 149). Mokslinėje literatūroje minima, kad tik kai kuriuose Nyderlandų regionuose naudojamasi visiškai įrengtais intensyvios medicinos pagalbos automobiliais, kuriuose lydinčią komandą sudaro intensyvios medicinos pagalbos gydytojas ir slaugytoja, tuo tarpu daugelyje įprastų greitosios medicinos pagalbos automobilių lydintysis yra tik gyvybę palaikyti gebantis paramedikas (Ligtenberg et al, 2005;Lieshout et al, 2008Lieshout et al, , p. 1270. Maždaug 90 % pervežimų organizuojami siunčiančios įstaigos personalo, naudojant tos įstaigos įrangą ir transportą.…”

“…trunkančių pratybų geba priimti teisingus sprendimus, susijusius su paciento pervežimu, remdamasis gairėmis, kuriose pagrindinis dėmesys skirtas diagnozei ir paciento būklei (Lieshout et al, 2008(Lieshout et al, , p. 1272.…”

An Observational Study of Decision Making by Medical Intensivists

“…M edical decision making is an inherently complex process, particularly among critically ill patients in whom multiple organ systems and social circumstances must be considered simultaneously (1)(2)(3)(4). To date, only one study has characterized the frequency with which decisions are made in the ICU (5).…”