To examine physicians’ decision making and its determinants about admission to intensive care.
Data Sources/Study Setting
physicians (n = 12) and internists (n = 12) working in a Swiss tertiary care hospital.
We conducted in‐depth interviews.
Data Collection/Extraction Methods
Interviews were analyzed using an inductive thematic approach.
Admission decisions regarding seriously ill or elderly patients with comorbidities are complex. Nonmedical factors such as beds availability, health care resources on the ward, information about patient preferences, and family behavior determine the decision. Code status and the quality of interaction between physicians are key determinants. The absence of code status or poor documentation of code status discussions makes decisions more difficult and laden emotionally, as physicians feel they are making a life‐death decision. Mutual respect and collaborative decision making facilitate the decision. Tensions arise due to physicians’ postponing the decision because of lack of beds, physicians’ dismissive attitudes, perceived shortcomings in the other physician's completion of expected tasks, and preconceptions about the other physician.
Systematic documentation of code status, and fostering collaboration between physicians and internists would facilitate admission decisions in complex clinical situations.
