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Table 2 Prevalence of and providers’ reasons for perceived inappropriate care in the intensive care unit

From: Perceptions of the appropriateness of care in California adult intensive care units

  Overall numerator/
denominator (percentage)a
Doctors Nurses P value
Prevalence of perceived inappropriate care
Providers identifying inappropriate care in 1+ patients on the day of the surveyb 447/1,169 (38.2) 94/184 (51.1) 353/985 (35.8) 0.000
Providers who did not identify a patient as receiving inappropriate care on the day of the survey but could identify a recent patient whose care was inappropriate 455/859 (53.0) 71/109 (65.1) 384/750 (51.2) 0.006
Reasons for inappropriate care
ICU is not the appropriate setting for this patient 271/430 (63.0) 61/93 (65.6) 210/337 (62.3) 0.562
 Patient is too well 117/271 (43.2) 15/61 (24.6) 102/210 (48.6) 0.001
 Patient is dying and could be better managed elsewhere 129/154 (83.8) 42/46 (91.3) 87/108 (80.6) 0.098
The amount of care being provided is disproportionate to the patient’s expected prognosis or wishes 325/429 (75.8) 74/93 (79.6) 251/336 (74.7) 0.332
 Amount of care inconsistent with expected survival 232/285 (81.4) 58/67 (86.6) 174/218 (79.8) 0.214
 Amount of care inconsistent with expected quality of life 258/300 (86.0) 67/70 (95.7) 191/230 (83.0) 0.007
 The amount of care provided is too much 300/323 (92.9) 73/74 (98.7) 227/249 (91.2) 0.028
 The amount of care provided is too little 23/323 (7.1) 1/74 (1.3) 22/249 (8.4) 0.028
Prognostic uncertainty contributes to inappropriate care 155/287 (54.0) 27/68 (39.7) 128/219 (58.5) 0.007
Fear of litigation 152/269 (56.5) 37/65 (56.9) 115/204 (56.4) 0.938
Patient/family ask to continue care that is inappropriate 236/298 (80.2) 62/71 (87.3) 174/227 (76.7) 0.053
Prevalence and reasons for perceived inappropriate care in the intensive care unit
Patient wishes are not known 165/267 (61.8) 42/65 (64.6) 123/202 (60.9) 0.591
Primary care team asks to continue disproportionate care 151/287 (52.6) 17/67 (25.4) 134/220 (60.9) 0.000
The primary care team does not wish to be involved in decision making 82/269 (30.5) 9/64 (14.1) 73/205 (35.6) 0.001
Communication issues between family and ICU team 138/287 (48.0) 31/70 (44.3) 107/217 (49.3) 0.465
Communication issues between ICU team and primary care team 98/267 (36.7) 12/63 (19.1) 86/204 (42.2) 0.001
Consequences to providers
Providers reporting that ‘inappropriate care’ situations cause them to feel quite, very, or extremely distressed 433/848 (51.1) 78/161 (48.4) 355/687 (51.7) 0.461
Providers who did not believe they had the ability to influence or change these situations 570/838 (68.0) 75/161 (46.6) 495/677 (73.1) 0.000
Providers who had never or only rarely attempted to intervene in these situations 386/837 (46.1) 35/157 (22.3) 351/680 (51.6) 0.000
  1. Each provider gave answers on only one patient, even if they had identified more than one receiving inappropriate care. aAll data are shown as number/total number (percentage). Denominators may differ because of missing data (respondents chose not to answer). bOne hundred thirty-nine respondents (10.8%) declined to answer this question. ICU, intensive care unit.