Survey: Clinicians see inappropriate care in ICUs

More than a quarter of intensive-care-unit clinicians view care in their ICUs as inappropriate at least some of the time, according to a study in the Journal of the American Medical Association. Perception of inappropriate care among staff can hinder teamwork efforts, contribute to burnout and increase turnover, the authors said.

Researchers surveyed more than 1,600 nurses and doctors working in ICUs in Europe and Israel. Of those respondents, 439, or 27%, said they perceived care to be inappropriate for at least one patient. The most commonly reported reason given was that ICU care was excessive. Also, some respondents said they thought other patients could benefit more from ICU care than those who received it.

“Repeated perceived inappropriateness of care may strongly influence perceptions of a new patient care situation and, as such, affect the quality of patient care,” the authors wrote. “Moreover, in our study perceived inappropriateness of care was independently associated with intentional job leave both in nurses and physicians.”

A number of factors were associated with clinicians' perception of appropriateness of care, including opportunities for shared decisionmaking and perceived workload.