Rule of rescue or the good of the many? An analysis of physicians’ and nurses’ preferences for allocating ICU beds

Abstract

More than one-third of ICU clinicians forewent substantial social benefits so as to devote resources to an individual patient unlikely to benefit from them. Such allegiance to the rule of rescue suggests challenges for efforts to reform ICU triage practices.

Hospital-Level Variation in ICU Admission and Critical Care Procedures for Patients Hospitalized for Pulmonary Embolism

“…For many patients, particularly those who require life-sustaining therapies, ICU admission is required to rescue patients from imminent death. 29 However, past work demonstrates that ICU admission may be more discretionary for patients at lower risk. 4,5,30 Chen et al 30 evaluated patients admitted to Veterans Administration hospitals and found signifi cant variation in ICU admission rates between hospitals that persisted aft er adjustment for both predicted mortality on admission and admission diagnosis.…”

Year in review in Intensive Care Medicine 2011: I. Nephrology, epidemiology, nutrition and therapeutics, neurology, ethical and legal issues, experimentals

“…Kohn and colleagues [67] sent questionnaires to a national sample of US ICU clinicians, soliciting their preferences for allocating their last bed to a gravely ill patient with little chance of surviving versus a deceased or dying patient for whom aggressive management could help others through organ donation. The authors received completed surveys from 684 of 2,206 physicians (31%) and 438 of 988 nurses (44%).…”

Visit to intensive care of 2050

“…This system exceeds the ability of any clinician to tailor patient management and assess their likelihood of survival. It is also free from bias stemming from the rule of rescue [2]. Triage is performed by this computerized system, with patients being admitted to the ICU only if data indicate that they will respond to treatment: if their telomeres demonstrate a tendency for longevity [3], their genetic testing demonstrates that they are not likely to develop non-iatrogenic complications; e.g.…”