More Related Content
Similar to The Final Bed: A National, Qualitative Study of Intensive Care Unit Clinicians' Reason for Rationing 5 5 11
Similar to The Final Bed: A National, Qualitative Study of Intensive Care Unit Clinicians' Reason for Rationing 5 5 11 (20)
More from Leonard Davis Institute of Health Economics
More from Leonard Davis Institute of Health Economics (20)
The Final Bed: A National, Qualitative Study of Intensive Care Unit Clinicians' Reason for Rationing 5 5 11
![The final bed: a national, qualitative study of intensive care unit clinicians’ reasons for rationing. Joanna L. Hart, MD 1 , Rachel Kohn, BA 1 , Scott D. Halpern, MD, PhD 1,2,3,4,5 1 Department of Medicine, 2 Division of Pulmonary and Critical Care Medicine, 3 Leonard Davis Institute of Health Economics, 4 Center for Bioethics, 5 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine Figure 1: Vignette provided to clinicians Suppose that your ICU has only 1 bed available when the ER requests urgent admission for these 2 patients: Patient A : 62 year-old male with non-recoverable anoxic brain injury following resuscitation for a cardiac arrest at home. He is intubated and unresponsive, but not brain dead . His advanced directive states that he would want life support withdrawn in such situations. His driver ’s license states his wish to donate his organs . To heed this wish, you would have to establish arterial and central venous access and resuscitate him for neurogenic shock. After the transplant team readies for organ procurement, you would extubate him and provide palliation at your discretion until he expires. If you choose to admit and manage this patient, his organs would provide a total of 5 extra years of life to patients awaiting transplant. Patient B : 62 year-old male with widely metastatic colon cancer responding poorly to chemotherapy has developed septic shock and multi-organ dysfunction syndrome . His advanced directive indicates a desire for a short trial of life-sustaining therapy for a potentially reversible illness. To heed this wish, you would have to establish arterial and central venous access and resuscitate him for septic shock. If you choose to admit and manage this patient, his estimated probability of surviving to ICU discharge would be 5% , in which case his oncologist believes he could live for up to 1 more year . Which patient should your ICU accept into the first available bed , assuming that both patients will ultimately be accepted but that any delay in ICU admission would decrease Patient A’s chances of becoming an organ donor or Patient B’s chances of survival? Table 1: Major themes within triage decision-making Table 2: Other emerging patterns ,[object Object],[object Object],[object Object],[object Object],Methods ,[object Object],[object Object],[object Object],[object Object],Results ,[object Object],[object Object],[object Object],[object Object],Conclusions ,[object Object],[object Object],Background ,[object Object],[object Object],Objectives](https://image.slidesharecdn.com/halpernscottqualititativerationaingats5511-110505114434-phpapp01/85/The-Final-Bed-A-National-Qualitative-Study-of-Intensive-Care-Unit-Clinicians-Reason-for-Rationing-5-5-11-1-320.jpg)
