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, 15 (4), R188

Managing Daily Intensive Care Activities: An Observational Study Concerning Ad Hoc Decision Making of Charge Nurses and Intensivists

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Managing Daily Intensive Care Activities: An Observational Study Concerning Ad Hoc Decision Making of Charge Nurses and Intensivists

Heljä Lundgrén-Laine et al. Crit Care.

Abstract

Introduction: Management of daily activities in ICUs is challenging. ICU shift leaders, charge nurses and intensivists have to make several immediate ad hoc decisions to enable the fluent flow of ICU activities. Even though the management of ICU activities is quite well delineated by international consensus guidelines, we know only a little about the content of the real clinical decision making of ICU shift leaders.

Methods: We conducted an observational study with the think-aloud technique to describe the ad hoc decision making of ICU shift leaders. The study was performed in two university-affiliated hospital ICUs. Twelve charge nurses and eight intensivists were recruited. Observations were recorded and transcribed for qualitative content analysis using the protocol analysis method. The software program NVivo 7 was used to manage the data. The interrater agreement was assessed with percentages and by Cohen's κ.

Results: We identified 463 ad hoc decisions made by the charge nurses and 444 made by the intensivists. During our data collection time, this breaks down to over 230 immediately made decisions per day (24 hours). We divided the ad hoc decision making of ICU shift leaders into two types: process-focused and situation-focused. Process-focused decision making included more permanent information, such as human resources, know-how and material resources, whereas situation-focused decision making included decisions about single events, such as patient admission. We named eight different categories for ICU ad hoc decision making: (1) adverse events, (2) diagnostics, (3) human resources and know-how, (4) material resources, (5) patient admission, (6) patient discharge, (7) patient information and vital signs and (8) special treatments.

Conclusions: ICU shift leaders make a great number of complex ad hoc decisions throughout the day. Often this decision making involves both intensivists and charge nurses. It forms a bundle that requires versatile, immediate information for a successful outcome. In the future, we need to investigate which information is crucial for ad hoc decision making. These challenges should also be emphasised when information technology programs for ICU care management are developed.

Figures

Figure 1
Figure 1
Process-focused (horizontal) and situation-focused (vertical) ad hoc decision making.
Figure 2
Figure 2
Examples of ad hoc decision-making bundles.

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References

    1. Ward NS, Snyder JE, Ross S, Haze D, Levy MM. Comparison of a commercially available clinical information system with other methods of measuring critical care outcomes data. J Crit Care. 2004;19:10–15. doi: 10.1016/j.jcrc.2004.02.003. - DOI - PubMed
    1. van Lieshout EJ, de Vos R, Binnekade JM, de Haan R, Schultz MJ, Vroom MB. Decision making in interhospital transport of critically ill patients: national questionnaire survey among critical care physicians. Intensive Care Med. 2008;34:1269–1273. doi: 10.1007/s00134-008-1023-x. - DOI - PMC - PubMed
    1. Fackler JC, Watts C, Grome A, Miller T, Crandall B, Pronovost P. Critical care physician cognitive task analysis: an exploratory study. Crit Care. 2009;13:R33. doi: 10.1186/cc7740. - DOI - PMC - PubMed
    1. Aitken LM, Marshall AP, Elliott R, McKinley S. Critical care nurses' decision making: sedation assessment and management in intensive care. J Clin Nurs. 2009;18:36–45. doi: 10.1111/j.1365-2702.2008.02318.x. - DOI - PubMed
    1. Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, Sam J, Haynes RB. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293:1223–1238. doi: 10.1001/jama.293.10.1223. - DOI - PubMed

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