Care for the critically ill may go too far for nearly a quarter of the patients in intensive care units, according to the physicians and nurses who care for them.
Clinicians felt they administered inappropriate care for 23% of patients treated in a single day across a subset of 69 ICUs in which patient data could be linked to clinician questionnaires, Ruth D. Piers, MD, of Ghent University Hospital in Ghent, Belgium, and colleagues found.
Among the full complement of survey respondents, 25% of 1,218 ICU nurses and 32% of 407 ICU physicians said they delivered inappropriate care to at least one of their patients on the day of the survey.
The most common reason cited — by 65% of respondents — was care disproportionate to the patient’s situation, nearly always “too much care,” the group reported in the Dec. 28 issue of the Journal of the American Medical Association.
“Clinicians in ICUs who perceive the care they provide as inappropriate experience moral distress and are at risk for burnout,” they wrote. “This situation may jeopardize patient quality of care and increase staff turnover.”
While concerning, the study offered only a “hazy” picture of why and what can or should be done about it, cautioned an accompanying editorial by Scott D. Halpern, MD, PhD, of the University of Pennsylvania in Philadelphia.
Clinician opinion hasn’t previously been considered relevant in determining whether the care delivered is the care that should be delivered, he noted.
And the validity of this subjective endpoint isn’t clear, Halpern added.
OK, so it’s an observational survey from a very small sample size (less than 100 ICU units and less than 500 ICU patients), but it definitely gets your attention. I like these type of ‘studies’ (if that’s what you want to call them), because it’s not really giving any valid empirical evidence for practice change, but is could be the preamble to something bigger or better.
I’m pretty sure there are plenty of ICU nurses out there that would have some great input regarding ‘too intensive’ care. End of life care seems to be blurring the lines between life-saving, life-sustaining, and death-prolonging these days.
What do you think? Follow the link and read the full article.