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 |