Chest
Original ResearchCritical CareInappropriate Care in European ICUs: Confronting Views From Nurses and Junior and Senior Physicians
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Study Design and Procedure
We conducted a cross-sectional study among nurses (defined as registered nurses, including head nurses and also including, in France, nursing assistants), junior physicians (defined as physicians in training), and senior physicians (including heads of ICUs) in European adult ICUs on a single day (Tuesday, May 11, 2010, at 8:00 am to Wednesday, May 12, 2010, at 8:00 am).11
Instruments
Each care provider working in the ICU on the day of the survey completed a questionnaire regarding personal characteristics
Participants and ICUs
Of the 1,651 staff members of 82 ICUs who completed the participant questionnaire and filled out the perceived inappropriate care question, 1,218 were nurses, 180 were junior physicians, and 227 were senior physicians; 26 failed to indicate their job titles. Basic demographic characteristics of the participating clinicians are given in Table 1. Participation rates, ICU characteristics, and participant characteristics are described in more detail in a previous article.11
In all, ICU clinicians
Discussion
We found that ICU care providers throughout Europe more or less agree on what the main issues of inappropriate care are. Nurses and junior and senior physicians indicate that a mismatch between level of care and prognosis (disproportionate care) is the most common cause of inappropriate care in the ICU. Remarkably, factors inside the ICU were the most important reasons for perceived disproportionate care. This perceived disproportionate care was more often ascribed to prognostic uncertainty by
Conclusions
In conclusion, ICU care providers feel that excessive care is a true issue in their daily ICU practice. Nurses charge physicians with a lack of initiative and poor communication, whereas physicians more often ascribe prognostic uncertainty as a reason as to why disproportionate care is continued. These are important targets for efforts to improve care for patients and working environments for clinicians.
Acknowledgments
Author contributions: As a principal investigator, R. D. P. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. R. D. P., E. A., B. R., F. D. G., J. D., and D. D. B. contributed to the study concept and design; R. D. P. and D. D. B. contributed to the design of the questionnaire; R. D. P., E. A., B. R., F. D. G., A. Max, A. Michalsen, P. A. M., R. O., F. R., J. D., and D. D. B. contributed to coordination of
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These data were presented at the 12th European Association for Palliative Care Congress, May 18-21, 2011, Lisbon, Portugal, and at the 24th European Society of Intensive Care Medicine Annual Congress, October 1-5, 2011, Berlin, Germany.
FUNDING/SUPPORT: This study was supported by a European Society of Intensive Care Medicine/European Critical Care Research Network award (iMDsoft Patient Safety Research Award, 10,000 €, Vienna 2009).
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