Nursing and Physician Perception of Inappropriate Intensive Care Support (NPPIIC)

About the study

Around 20% of patients admitted to intensive care do not survive to get home. For many of these patients it is difficult to predict if they are likely to survive.

However, there are some patients in intensive care who the doctors and nurses think it highly likely they will never leave hospital alive or if they do will require full time nursing care.

In this situation, depending upon the goals of the individual patient, providing medical intervention to prolong life may be inappropriate. Lengthy, drawn out deaths on intensive care are very unpleasant for families. Providing inappropriate care is a leading cause of burnout for clinical staff. Indeed, intensive care medicine has one of the highest rates of burnout both within health care and when compared with other professional groups outside of healthcare.

There is very little information on how often clinical staff feel they are providing care that cannot help a patient to return to a level of function that would be acceptable to that patient. We have no UK data regarding this.

In one study in America around 11 % of patients in one large hospital in California were identified as receiving futile care. None of these patients survived to go home and live independently. In a large study in Europe (excluding the UK) in 2010, 27% of doctors and nurses felt that at least one patient they were looking after on that one study day was receiving inappropriate levels of intensive care support, and in almost all cases this was too much support.

However, large health care and cultural differences exist between mainland Europe, the USA and the UK which may translate to significant differences in what we consider inappropriate care delivery.

Aims

We will study 13 intensive care units in the South West of England. We will look at how often and why doctors and nurses perceive patients are receiving inappropriate levels of intensive care support. We will also look to see whether there are large differences between nursing staff and doctors’ perceptions and will investigate the outcome of patients who receive support that was felt to be inappropriate.

Method

This is an observational study. We will be using a questionnaire which staff will fill out anonymously. No-one will know who gave what answers though the study investigators will know which patient the answers refer to. Patients identified as receiving inappropriate intensive care support will be followed up via their GP to see if they are alive 6 months later. If the patients are alive, we will also ask the GP whether they have returned to their home address, are still in hospital, or if they now require residential or nursing home care.

Outcomes

Incidence of perceived inappropriate levels of organ support in intensive care units in South West of England.  Identify key reasons care is perceived to be inappropriate, the level of agreement between doctors and nurses and patient outcome at 6 months.

Implications

If intensive care support which is felt to be inappropriate, is being delivered frequently, we need to look into why this is happening. If patients perceived to be receiving inappropriate organ support make good recoveries by 6 months, then staff wellbeing may benefit from enhanced feedback regarding patient outcome. If patient outcome is unanimously poor at 6 months, then this may suggest we need to work upon our communication between medical teams, patients and families, to ensure we are making decisions that genuinely serve patients best interests.