Conflict in the care of patients with prolonged stay in the ICU: types, sources, and predictors
To determine types, sources, and predictors of conflicts among patients with prolonged stay in the ICU. 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-...
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| Veröffentlicht in: | Intensive care medicine 2003-09, Vol.29 (9), p.1489-1497 |
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| container_title | Intensive care medicine |
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| creator | STUDDERT, David M MELLO, Michelle M BURNS, Jeffrey P PUOPOLO, Ann Louise GALPER, Benjamin Z TRUOG, Robert D BRENNAN, Troyen A |
| description | To determine types, sources, and predictors of conflicts among patients with prolonged stay in the ICU.
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.
Seven medical and surgical ICUs at four teaching hospitals in Boston, USA.
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).
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).
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. |
| doi_str_mv | 10.1007/s00134-003-1853-5 |
| format | Article |
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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.
Seven medical and surgical ICUs at four teaching hospitals in Boston, USA.
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).
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).
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.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-003-1853-5</identifier><identifier>PMID: 12879243</identifier><identifier>CODEN: ICMED9</identifier><language>eng</language><publisher>Heidelberg: Springer</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Boston ; Case-Control Studies ; Communication Barriers ; Critical Care - statistics & numerical data ; Decision Making ; Dissent and Disputes ; Ethics ; Family Relations ; Female ; Humans ; Intensive Care Units - statistics & numerical data ; Interprofessional Relations ; Length of Stay ; Male ; Medical sciences ; Middle Aged ; Professional-Family Relations ; Prospective Studies ; Reproducibility of Results ; Time Factors</subject><ispartof>Intensive care medicine, 2003-09, Vol.29 (9), p.1489-1497</ispartof><rights>2004 INIST-CNRS</rights><rights>Copyright Springer-Verlag 2003</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c397t-b6ac30cc7759c30647f097ede17f4fbc6e1dedc96faa045de492738a0ac416a23</citedby><cites>FETCH-LOGICAL-c397t-b6ac30cc7759c30647f097ede17f4fbc6e1dedc96faa045de492738a0ac416a23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15135673$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12879243$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>STUDDERT, David M</creatorcontrib><creatorcontrib>MELLO, Michelle M</creatorcontrib><creatorcontrib>BURNS, Jeffrey P</creatorcontrib><creatorcontrib>PUOPOLO, Ann Louise</creatorcontrib><creatorcontrib>GALPER, Benjamin Z</creatorcontrib><creatorcontrib>TRUOG, Robert D</creatorcontrib><creatorcontrib>BRENNAN, Troyen A</creatorcontrib><title>Conflict in the care of patients with prolonged stay in the ICU: types, sources, and predictors</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><description>To determine types, sources, and predictors of conflicts among patients with prolonged stay in the ICU.
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.
Seven medical and surgical ICUs at four teaching hospitals in Boston, USA.
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).
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).
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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Boston</subject><subject>Case-Control Studies</subject><subject>Communication Barriers</subject><subject>Critical Care - statistics & numerical data</subject><subject>Decision Making</subject><subject>Dissent and Disputes</subject><subject>Ethics</subject><subject>Family Relations</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Interprofessional Relations</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Professional-Family Relations</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Time Factors</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNpdkEtrGzEUhUVpaBwnPyCbIgrJKpPq6jmTXTB5gSGbZi1kzVU8ZjzjSjLB_z4ydgl0de_iO4fDR8glsFtgzPxOjIGQFWOiglqJSn0jE5CCV8BF_Z1MmJC8klryU3KW0qrQRiv4QU6B16bhUkyInY1D6DufaTfQvETqXUQ6BrpxucMhJ_rR5SXdxLEfh3dsacpu9499mb3d0bzbYLqhadxGv3_c0BYc29I5xnROToLrE14c75S8PT78mT1X89enl9n9vPKiMblaaOcF894Y1ZRHSxNYY7BFMEGGhdcILba-0cE5JlWLsuFG1I45L0E7Lqbk-tBblv7dYsp23SWPfe8GHLfJGlE0gGoK-Os_cFWWD2Wb5aCh1rWGAsEB8nFMKWKwm9itXdxZYHav3h7U26Le7tVbVTI_j8XbxRrbr8TRdQGujoBL3vUhusF36YtTIJQ2QnwC3ZCLNg</recordid><startdate>20030901</startdate><enddate>20030901</enddate><creator>STUDDERT, David M</creator><creator>MELLO, Michelle M</creator><creator>BURNS, Jeffrey P</creator><creator>PUOPOLO, Ann Louise</creator><creator>GALPER, Benjamin Z</creator><creator>TRUOG, Robert D</creator><creator>BRENNAN, Troyen A</creator><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20030901</creationdate><title>Conflict in the care of patients with prolonged stay in the ICU: types, sources, and predictors</title><author>STUDDERT, David M ; MELLO, Michelle M ; BURNS, Jeffrey P ; PUOPOLO, Ann Louise ; GALPER, Benjamin Z ; TRUOG, Robert D ; BRENNAN, Troyen A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c397t-b6ac30cc7759c30647f097ede17f4fbc6e1dedc96faa045de492738a0ac416a23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Boston</topic><topic>Case-Control Studies</topic><topic>Communication Barriers</topic><topic>Critical Care - statistics & numerical data</topic><topic>Decision Making</topic><topic>Dissent and Disputes</topic><topic>Ethics</topic><topic>Family Relations</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Interprofessional Relations</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Professional-Family Relations</topic><topic>Prospective Studies</topic><topic>Reproducibility of Results</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>STUDDERT, David M</creatorcontrib><creatorcontrib>MELLO, Michelle M</creatorcontrib><creatorcontrib>BURNS, Jeffrey P</creatorcontrib><creatorcontrib>PUOPOLO, Ann Louise</creatorcontrib><creatorcontrib>GALPER, Benjamin Z</creatorcontrib><creatorcontrib>TRUOG, Robert D</creatorcontrib><creatorcontrib>BRENNAN, Troyen A</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>STUDDERT, David M</au><au>MELLO, Michelle M</au><au>BURNS, Jeffrey P</au><au>PUOPOLO, Ann Louise</au><au>GALPER, Benjamin Z</au><au>TRUOG, Robert D</au><au>BRENNAN, Troyen A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Conflict in the care of patients with prolonged stay in the ICU: types, sources, and predictors</atitle><jtitle>Intensive care medicine</jtitle><addtitle>Intensive Care Med</addtitle><date>2003-09-01</date><risdate>2003</risdate><volume>29</volume><issue>9</issue><spage>1489</spage><epage>1497</epage><pages>1489-1497</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><coden>ICMED9</coden><abstract>To determine types, sources, and predictors of conflicts among patients with prolonged stay in the ICU.
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.
Seven medical and surgical ICUs at four teaching hospitals in Boston, USA.
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).
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).
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.</abstract><cop>Heidelberg</cop><cop>Berlin</cop><pub>Springer</pub><pmid>12879243</pmid><doi>10.1007/s00134-003-1853-5</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Intensive care medicine, 2003-09, Vol.29 (9), p.1489-1497 |
| issn | 0342-4642 1432-1238 |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Adult Aged Aged, 80 and over Biological and medical sciences Boston Case-Control Studies Communication Barriers Critical Care - statistics & numerical data Decision Making Dissent and Disputes Ethics Family Relations Female Humans Intensive Care Units - statistics & numerical data Interprofessional Relations Length of Stay Male Medical sciences Middle Aged Professional-Family Relations Prospective Studies Reproducibility of Results Time Factors |
| title | Conflict in the care of patients with prolonged stay in the ICU: types, sources, and predictors |
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