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Intensive Care Med. 2003 Sep;29(9):1489-97. Epub 2003 Jul 19.

Conflict in the care of patients with prolonged stay in the ICU: types, sources, and predictors.

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1
Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. studdert@hsph.harvard.edu

Abstract

OBJECTIVE:

To determine types, sources, and predictors of conflicts among patients with prolonged stay in the ICU.

DESIGN AND SETTING:

We prospectively identified conflicts by interviewing treating physicians and nurses at two stages during the patients' stays. We then classified conflicts by type and source and used a case-control design to identify predictors of team-family conflicts.

DESIGN AND SETTING:

Seven medical and surgical ICUs at four teaching hospitals in Boston, USA.

PATIENTS:

All patients admitted to the participating ICUs over an 11-month period whose stay exceeded the 85th percentile length of stay for their respective unit ( n=656).

MEASUREMENTS AND RESULTS:

Clinicians identified 248 conflicts involving 209 patients; hence, nearly one-third of patients had conflict associated with their care: 142 conflicts (57%) were team-family disputes, 76 (31%) were intrateam disputes, and 30 (12%) occurred among family members. Disagreements over life-sustaining treatment led to 63 team-family conflicts (44%). Other leading sources were poor communication (44%), the unavailability of family decision makers (15%), and the surrogates' (perceived) inability to make decisions (16%). Nurses detected all types of conflict more frequently than physicians, especially intrateam conflicts. The presence of a spouse reduced the probability of team-family conflict generally (odds ratio 0.64) and team-family disputes over life-sustaining treatment specifically (odds ratio 0.49).

CONCLUSIONS:

Conflict is common in the care of patients with prolonged stays in the ICU. However, efforts to improve the quality of care for critically ill patients that focus on team-family disagreements over life-sustaining treatment miss significant discord in a variety of other areas.

PMID:
12879243
DOI:
10.1007/s00134-003-1853-5
[Indexed for MEDLINE]
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