Implementing an intervention to improve decision-making around referral and admission to intensive care: results of feasibility testing in three NHS Hospitals

Why it matters

When patients are critically ill or injured, doctors face high-pressure decisions about whether to refer or admit them to the intensive care unit (ICU).

Though ICU treatment can save lives, it can also cause health problems that linger for years. And these decisions are often made without knowing the patient’s wishes, as their condition deteriorates.

Without any guidance or frameworks to support them, doctors’ decisions to refer or admit patients to ICU are inconsistent, and the reasons behind them aren’t always clear. This has raised concerns about whether critically ill patients are consistently able to access appropriate treatments.

Given these challenges, there is a clear need to support clinicians in making decisions about whether to refer and admit patients to the ICU.

Our approach

This study aims to develop and test an intervention aimed to help clinicians make transparent, patient-centred and ethically-justified decisions about referring and admitting patients to the ICU.

The intervention consisted of a decision-support framework and patient information leaflets, which were developed as part of a larger study funded by the National Institute for Health Research (NIHR), and informed by a systematic review, ethnography, and stakeholder engagement.

The intervention was implemented in three NHS hospitals in England and evaluated for its feasibility, acceptability and perceived impact. The mixed methods evaluation included a quantitative assessment of the intervention’s use, and qualitative interviews with clinicians.

What we found

• The intervention saw moderate uptake, used in 28% of ICU referrals across the three hospitals, but patient and family information leaflets were not regularly used
• Use of the intervention was influenced by the hospital’s organisational culture and structure
• Clinicians expressed concerns about the additional work due to the intervention
• When used, the intervention appeared to encourage more transparent and patient-centred decision making and improved communication between staff
• Doctors reported positive impacts on their decisions, including greater attention to patient wishes

Related content from our open-access series, Elements of Improving Quality and Safety in Healthcare