Perceived inappropriateness of care in the ICU: what to make of the clinician's perspective?

摘要

Overall, the APPROPRICUS study builds from smaller studies45 to provide the best evidence to date regarding the epidemiology of perceived inappropriateness of care. Generalizing the results beyond European and Israeli ICUs is challenging because most of the ICUs studied used closed staffing models, low patient-to-intensivist ratios, and 24-hour attending intensivist supervision—charactertistics not shared by many US or Canadian ICUs. Nonetheless, the large and diverse sample, remarkably high response rate, strong conceptual model, and ability to link clinician observations to individual patients are all substantial strengths. Furthermore, findings such as discordant perceptions of inappropriate care may in fact be higher in the United States, where multiple attending physicians and consultants may be involved in care decisions. Thus, it is important to ask why such a large number of clinicians are providing care they perceive to be inappropriate, and what can or should be done about it?