Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 24;11(3):e044752.
doi: 10.1136/bmjopen-2020-044752.

UK consultants' experiences of the decision-making process around referral to intensive care: an interview study

Kaja Heidenreich  1 , Anne-Marie Slowther  2 , Frances Griffiths  2 , Anders Bremer  3 , Mia Svantesson  4
Affiliations

UK consultants' experiences of the decision-making process around referral to intensive care: an interview study

Kaja Heidenreich et al. BMJ Open. .

Abstract

Objective: The decision whether to initiate intensive care for the critically ill patient involves ethical questions regarding what is good and right for the patient. It is not clear how referring doctors negotiate these issues in practice. The aim of this study was to describe and understand consultants' experiences of the decision-making process around referral to intensive care.

Design: Qualitative interviews were analysed according to a phenomenological hermeneutical method.

Setting and participants: Consultant doctors (n=27) from departments regularly referring patients to intensive care in six UK hospitals.

Results: In the precarious and uncertain situation of critical illness, trust in the decision-making process is needed and can be enhanced through the way in which the process unfolds. When there are no obvious right or wrong answers as to what ought to be done, how the decision is made and how the process unfolds is morally important. Through acknowledging the burdensome doubts in the process, contributing to an emerging, joint understanding of the patient's situation, and responding to mutual moral duties of the doctors involved, trust in the decision-making process can be enhanced and a shared moral responsibility between the stake holding doctors can be assumed.

Conclusion: The findings highlight the importance of trust in the decision-making process and how the relationships between the stakeholding doctors are crucial to support their moral responsibility for the patient. Poor interpersonal relationships can damage trust and negatively impact decisions made on behalf of a critically ill patient. For this reason, active attempts must be made to foster good relationships between doctors. This is not only important to create a positive working environment, but a mechanism to improve patient outcomes.

Keywords: adult intensive & critical care; medical ethics; qualitative research.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Similar articles

See all similar articles

References

    1. Brinkman S, de Jonge E, Abu-Hanna A, et al. . Mortality after hospital discharge in ICU patients. Crit Care Med 2013;41:1229–36. 10.1097/CCM.0b013e31827ca4e1 - DOI - PubMed
    1. Williams TA, Dobb GJ, Finn JC, et al. . Determinants of long-term survival after intensive care. Crit Care Med 2008;36:1523–30. 10.1097/CCM.0b013e318170a405 - DOI - PubMed
    1. Montuclard L, Garrouste-Orgeas M, Timsit JF, et al. . Outcome, functional autonomy, and quality of life of elderly patients with a long-term intensive care unit stay. Crit Care Med 2000;28:3389–95. 10.1097/00003246-200010000-00002 - DOI - PubMed
    1. ICNARC . Key statistics from the Case Mix Programme - Adult, general critical care units 1, April 2015 to 31 March 2016. 2017.
    1. Mnatzaganian G, Galai N, Sprung CL, et al. . Increased risk of bloodstream and urinary infections in intensive care unit (ICU) patients compared with patients fitting ICU admission criteria treated in regular wards. J Hosp Infect 2005;59:331–42. 10.1016/j.jhin.2004.07.028 - DOI - PubMed

Publication types

LinkOut - more resources