An Observational Study of Decision Making by Medical Intensivists

Abstract

Intensivists made over 100 daily critical care decisions during rounds. The number of decisions was influenced by a variety of patient- and system-related factors and was highly variable among intensivists. Future work is needed to explore effects of the decision-making burden on providers' choices and on patient outcomes.

Accuracy of Laboratory Data Communication on ICU Daily Rounds Using an Electronic Health Record*

“…With over 1,300 new data points/ICU patient per day, clinicians face information overload and may suffer from cognitive fatigue (12–14). Despite evidence suggesting that physicians who have been in clinical practice longer integrate data more successfully than those with less clinical experience, historic precedence in academic centers relegates the majority of data gathering to the least experienced physician on the team (15, 16).…”

Aligning critical care interventions with patient goals: A modified Delphi study

“…Lastly, physicians and nurses were asked to review a list of 59 interventions and indicate (yes vs. no), whether each intervention fit the three criteria. This initial list of 59 interventions was derived from previous work enumerating and classifying tests and procedures commonly performed in ICUs 5,34 with additional input from critical care clinicians.…”

“…5 In a busy ICU this means making hundreds of decisions over a few hours. The vast majority of these decisions (e.g., electrolyte replacement) are unlikely to benefit from patient input.…”

What do non-critical care residents actually learn during an intensive care unit rotation: time to find out!

“…For example, it has been reported that ICU physicians make over 100 decisions daily during rounds, and few of these decisions relate to teaching or resident feedback. 21 These represent just a few examples that force us to question the ability of ICU supervisors to provide rotating non-critical care residents with high-quality assessments that are accurate, fair, and meaningful.…”