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An observational study of critical care physicians' assessment and decision-making practices in response to patient referrals

Charlesworth, Michael and Mort, Maggie and Smith, Andrew F. (2017) An observational study of critical care physicians' assessment and decision-making practices in response to patient referrals. Anaesthesia, 72 (1). pp. 80-92. ISSN 0003-2409

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    Abstract

    Previous studies of critical care admissions have largely compared patients that have been granted or declined admission. To better understand the decision process itself, our ethnographic approach combined observation of and interviews with critical care physicians in a large English hospital. We observed 30 critical care doctors managing 71 referrals and conducted ten interviews with senior decision-makers to explore the themes raised by our observations. We analysed data using the constant comparative method. We found that the decision to move a patient to critical care was just one way in which the trajectory of critical illness could be modified. When patients were admitted to critical care, it was not always for invasive monitoring or advanced organ support, with some admitted for more general medical and/or nursing care. When patients were declined admission, they were not simply forgotten or left behind; they nevertheless underwent careful assessment and follow-up. Thus, depicting admission or refusal as a binary event is misleading. We suggest that prescriptive admission algorithms are problematic for clinicians, in that they may not take into account the complexity of clinical practice.

    Item Type: Journal Article
    Journal or Publication Title: Anaesthesia
    Additional Information: This is the peer reviewed version of the following article: Charlesworth, M., Mort, M. and Smith, A. F. (2017), An observational study of critical care physicians' assessment and decision-making practices in response to patient referrals. Anaesthesia, 72: 80–92. doi:10.1111/anae.13667 which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/anae.13667/abstract This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.
    Uncontrolled Keywords: /dk/atira/pure/subjectarea/aacsb/disciplinebasedresearch
    Subjects: ?? ADMITTING DEPARTMENTCRITICAL CAREDECISION-MAKINGETHNOGRAPHYHOSPITALDISCIPLINE-BASED RESEARCH ??
    Departments: Faculty of Arts & Social Sciences > Sociology
    Faculty of Health and Medicine > Medicine
    ID Code: 84062
    Deposited By: ep_importer_pure
    Deposited On: 01 Feb 2017 14:50
    Refereed?: Yes
    Published?: Published
    Last Modified: 30 Apr 2019 02:29
    Identification Number:
    URI: http://eprints.lancs.ac.uk/id/eprint/84062

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