Decision-making in ICU – A systematic review of factors considered important by ICU clinician decision makers with regard to ICU triage decisions

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Background:The ICU is a scarce resource within a high-stress, high-stakes, time-sensitive environment where critically ill patients with life-threatening conditions receive expensive life-sustaining care under the guidance of expert qualified personnel. The implications of decisions such as suitability for admission into ICU are potentially dire and difficult.Objectives:To conduct a systematic review of clinicians' subjective perceptions of factors that influence the decision to accept or refuse patients referred to ICU.Results:Twenty studies yielded 56 different factors classified into patient, physician and environmental. Common, important factors were: acute illness severity and reversibility; presence and severity of comorbidities; patient age, functional status, state-of-mind and wishes; physician level of experience and perception of patient QOL; and bed availability. Within-group variability among physicians and thought-deed discordance were demonstrated.Conclusions:The complex and dynamic ICU triage decision is affected by numerous interacting factors. The literature provides some indication of these factors, but fail to show complexities and interactions between them. A decision tree is proposed. Further research should include a reflection on how decisions for admission to ICU are made, such that a better understanding of these processes can be achieved allowing for improved individual and group consistency.HIGHLIGHTSPatient, physician and environmental factors affect decision.Acute illness severity and reversibility crucial to considerPatient age, comorbidities, functional status, state-of-mind and wishes importantPhysician experience & perception of patient QOL and bed availability importantPhysician variability, thought-deed discordance and factor interaction are vital.

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