Receiving Too Much Attention in ICU?

Perception of excess care in ICU may increase clinical staff turnover

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Is there really such a thing as receiving too much care in a hospital's intensive care unit? Doctors and nurses think so and it may be jeopardizing the quality of care patients receive, while increasing staff turnover.

Physicians and nurses have indicated that the perception of inappropriate care, most commonly an excess intensity of care for a patient, occurs regularly and may impact decision sharing, communication and put medical staff at a high risk of burnout.

"Communicate with all clinicians to maximize your hospital care."

Dr. Ruth D. Piers, of Ghent University Hospital in Belgium, found that inappropriate care is significantly associated with intent to leave a current clinical position, placing a significant burden on the well-being of doctors and nurses. It also may play a role in the quality of care patients receive.

During the 2010 study, researchers collected questionnaires regarding the perception of inappropriate care in at least one patient from 1,651 ICU nurses and physicians. Responses came from 82 adult ICUs in nine European countries and Israel.

About 27 percent of those surveyed reported inappropriateness of care in at least one patient, with a higher percentage of doctors reporting inappropriate care at 32 percent, than nurses at 25 percent.

The most common type of inappropriate care was reported as disproportionate care at 65 percent, with clinicians perceived to be giving excessive care in 89 percent of incidents, and insufficient care in 11 percent of cases.

Additionally, 38 percent felt that other patients could better benefit from ICU care than the present patient. Doctors indicated they felt this was a significantly more common inappropriate care problem than nurses.

The findings were linked to an impact on the well-being of physicians and nurses, higher staff turnover, and concern that patient care could suffer.

An analysis indicated that a number of factors were linked to lower perceived inappropriateness of care rates including symptom control shared with nurses as opposed to only doctors, involvement of nurses in end-of-life decisions, collaboration between doctors and nurses and freedom to perform work tasks independently. For nurses this also included a lower perceived workload.

The study was published in the Dec. 28 edition of the Journal of the American Medical Association.

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Review Date: 
December 28, 2011
Last Updated:
December 31, 2011