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British Journal of Anaesthesia, 2000, Vol. 84, No. 5 661-662
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia

Abstract

The influence of intensive care unit (ICU) workload on decisions to withdraw treatment

J. S. Bewley1, F. E. M. Braddon2, K. Waters2 and A. R. Manara1

1 Intensive Care Unit, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, UK
2 Research and Development Support Unit, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, UK

Abstract

The incidence of treatment withdrawal is increasing across Europe and the UK, a recent report from this unit showing that treatment is withdrawn in 12.5% of patients admitted to ICU and accounts for 60% of all deaths in the ICU.1 Nationally, data from the Intensive Care National Audit and Research Centre (ICNARC) report a withdrawal rate of 11.8%, accounting for over 50% of all deaths in intensive care.2 The effect of workload on treatment withdrawal has not been specifically examined previously, although data from ICNARC suggest that treatment is withdrawn from an increased proportion of ICU patients in the winter months when the pressure on ICU facilities is known to be greatest.2

We have collected data on treatment withdrawal prospectively for the 3-yr period March 1996 – February 1999. During this time 1574 patients were admitted to ICU and treatment was withdrawn in 200 (12.7%) patients. The daily rate of treatment withdrawal was correlated with the daily bed occupancy over this period. The time (in hours) from admission to ICU until the decision to withdraw treatment was made, was calculated. This was then correlated with the number of patients admitted to ICU on the day that treatment was withdrawn (Tables 5 and 6).

These data suggest that an increase in ICU workload does not increase the frequency with which treatment is withdrawn, but that it does however result in the decision to withdraw treatment being made earlier in the course of the patient’s ICU stay. It is essential to ensure that the decision-making and its timing are as appropriate when ICU facilities are under pressure as when they are not. Further analysis of ICNARC data is necessary to determine if workload is a factor influencing the decision nationally.


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