Nicht indizierte Aufnahmen auf der Intensivstation

Bangert, K.; Borch, J.; Ferahli, Sabine; Braune, Stephan; Heer, Geraldine de; Kluge, Stefan

doi:10.1007/s00063-015-0070-7

Cited by 5 publications

(1 citation statement)

References 13 publications

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“…Similarly, a study in the UK found that 17.2% of ICU physicians would have admitted to the ICU a patient whose probability of survival was estimated to be less than 1% [10]. In their prospective, single-centre study from Germany, Bangert et al reported that among the 50 patients for whom the ICU admission was considered to be futile by interdisciplinary consensus, 82% had expressed (either directly, or in writing through advanced directives, or through a family member) the desire not to be admitted to intensive care [11], whereas the corresponding percentage in our study was 23%. Cultural differences between countries, including legislative aspects, could at least partially explain these conflicting findings [12, 13].…”

Section: Discussionmentioning

confidence: 99%

What are the characteristics that lead physicians to perceive an ICU stay as non-beneficial for the patient?

Quenot

Large²,

Meunier-Beillard

et al. 2019

PLoS ONE

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Purpose We 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 methods In 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. Results Among 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]). Conclusions Non-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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