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. 2019 Sep 6;14(9):e0222039.
doi: 10.1371/journal.pone.0222039. eCollection 2019.

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

Jean-Pierre Quenot  1   2   3 , Audrey Large  1 , Nicolas Meunier-Beillard  3   4 , Paul-Simon Pugliesi  5 , Pamina Rollet  6 , Amaury Toitot  6 , Pascal Andreu  1 , Hervé Devilliers  3   7 , Antoine Marchalot  8 , Fiona Ecarnot  9 , Auguste Dargent  1   2 , Jean-Philippe Rigaud  8   10 ; INSTINCT study group
Affiliations

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

Jean-Pierre Quenot et al. PLoS One. .

Abstract

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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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of the participating centres and study population.
NBS, non-beneficial stay in the intensive care unit.
See this image and copyright information in PMC

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