Hence, a good collaboration between the two doctors is needed, which supposes availability of clinical information, efficient communication and decision autonomy of collaborators. The two doctors must work together and share their clinical expertise to make the best decision for the patient. The intensivist assesses the patient and discusses the situation with the internist, before the admission decision is made. When a medical in-patient becomes critically ill, the situation is assessed by the internist, who determines whether intensive care is needed and whether the intensivist should be called. ICU admission decisions involve the internist on the ward and the ICU doctor. Admissions decisions on general internal medicine wards may involve assessment of patients with advanced diseases or elderly patients with multiple comorbidities, for whom the appropriateness of intensive care is uncertain. Such decisions are made under time pressure and in a context of fair allocation of resources. Training in communication skills and interprofessional education interventions aimed at a better understanding of each other roles would improve collaboration.ĭecisions to admit a patient to intensive care (ICU) are often complex. Conclusionsĭespite a common perception of each other’s practical roles, tensions can arise between internists and intensivists in complex situations of ICU admission decisions.
Internists’ identity roles were those of leader and partner. These roles could be perceived as emotionally burdensome. Intensivists’ identity roles included those of leader, gatekeeper, life-death decision maker, and supporting colleague doctors (consultant, senior and helper). In complex situations, perceived flaws in performing practical roles could create tensions between the doctors. Intensivists’ practical roles were: assessing the patient on the ward, giving expert advice, making quick decisions, managing access to the ICU, having the final decision power and, sometimes, deciding whether or not to limit treatment. Internists’ practical roles were: recognizing signs of severity when the patient becomes acutely ill, calling the intensivist at the right moment, having the relevant information about the patient and having determined the goals of care. Internist and intensivists had the same perception of each other’s practical roles. Roles could be divided into practical roles and identity roles.
Interviews were analyzed using a thematic approach. Individual in-depth interviews with 12 intensivists and 12 internists working at a Swiss teaching hospital. The objective was to explore how internists and intensivists perceive their roles during admission decisions. Clear perception of each other’s roles is a prerequisite for good collaboration. Intensive care Unit (ICU) admission decisions involve collaboration between internists and intensivists.