Patient-related factors and circumstances surrounding decisions to forego life-sustaining treatment, including intensive care unit admission refusal*

Abstract

All patients deemed too sick for ICU admission had decisions to forego LST. These decisions were made without direct patient examination in two-thirds of refused patients (vs. none of admitted patients) and were associated with less involvement of nurses and relatives compared with decisions in admitted patients. Further work is needed to improve decisions to forego LST made under the distinctive circumstances of triage.

Determinants and outcomes associated with decisions to deny or to delay intensive care unit admission in Morocco

“…Several studies found that 8-13% of triaged patients were considered too sick to benefit from ICU admission [6,[17][18][19]. Our result was concordant with the literature data.…”

“…The percentage of hospital mortality of the never admitted patients in the current study was similar to the one observed in earlier studies [6,[13][14][15][16][17][18][19][20][21][22][23][24][25]. This is easily explained by the fact that refused patients were older and had higher severity of illness.…”

“…In European and Asian ICUs, this rate varied greatly from 23 to 72% [6,19,20]. The high refusal rate in our study may be explained by the fact that our medical ICU is a major referral center for the northwestern region in Morocco with a limited number of beds (12 beds [21].…”

Pattern of end-of-life decisions in two Tunisian intensive care units: the role of culture and intensivists’ training

“…Some other factors are also reported in the literature, such as demographic characteristics, acute conditions with poor prognosis, environmental factors, sepsis, and multiple organ failure [4,6,22,34,[36][37][38][39][40]. Although nosocomial infections were more frequent in patients with WH or WD decisions compared to those who died with full support, the difference did not achieve the level of statistical significance in our study.…”

The Ethics and Reality of Rationing in Medicine

“…10,000 ICU bed triage decisions across North America, Europe, Israel, and Hong Kong, at least 15% of patients were refused ICU admission, of which approximately 15% were attributed to lack of beds. 9,29,30 Additionally, during times of ICU bed shortages, admitted patients were more ill at both ICU admission and discharge, average lengths of stay were shorter, and fewer patients were admitted for monitoring, which suggests that some patients are denied potentially benefi cial treatment in times of ICU bed shortages. 9 Some centers have attempted to reduce ICU use by making mechanical ventilation available on the wards.…”