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Intensive Care Medicine
Published in: Intensive Care Medicine 9/2003

01-09-2003 | Original

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

Authors: David M. Studdert, Michelle M. Mello, Jeffrey P. Burns, Ann Louise Puopolo, Benjamin Z. Galper, Robert D. Truog, Troyen A. Brennan

Published in: Intensive Care Medicine | Issue 9/2003

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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.
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Metadata
Title
Conflict in the care of patients with prolonged stay in the ICU: types, sources, and predictors
Authors
David M. Studdert
Michelle M. Mello
Jeffrey P. Burns
Ann Louise Puopolo
Benjamin Z. Galper
Robert D. Truog
Troyen A. Brennan
Publication date
01-09-2003
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 9/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-1853-5

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