Service de Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Dieppe, France.
Service de Médecine Intensive Réanimation, Université de Bourgogne Franche Comté, CHU de Dijon, Dijon, France.
PLoS One. 2018 Oct 18;13(10):e0205689. doi: 10.1371/journal.pone.0205689. eCollection 2018.
We investigated, using a multicentre survey of practices in France, the practices of ICU physicians concerning the decision not to readmit to the ICU, in light of current legislation.
Multicentre survey of practices among French ICU physicians via electronic questionnaire in January 2016. Questions related to respondents' practices regarding re-admission of patients to the ICU and how these decisions were made. Criteria were evaluated by the health care professionals as regards importance for non-readmission.
In total, 167 physicians agreed to participate, of whom 165 (99%) actually returned a completed questionnaire from 58 ICUs. Forty-five percent were aged <35 years, 74% were full-time physicians. The findings show that decisions for non-readmission are taken at the end of the patient's stay (87%), using a collegial decision-making procedure (89% of cases); 93% reported that this decision was noted in the patient's medical file. While 73% indicated that the family/relatives were informed of non-readmission decisions, only 29% reported informing the patient, and 91% considered that non-readmission decisions are an integral part of the French legislative framework.
This study shows that decisions not to re-admit a patient to the ICU need to be formally materialized, and anticipated by involving the patient and family in the discussions, as well as the other healthcare providers that usually care for the patient. The optimal time to undertake these conversations is likely best decided on a case-by-case basis according to each patient's individual characteristics.
我们通过对法国多家重症监护中心（ICU）的实践进行多中心调查，根据现行立法，调查 ICU 医生在决定不再将患者收入 ICU 时的实践情况。
2016 年 1 月，通过电子问卷对法国 ICU 医生进行多中心实践调查。问题涉及到患者重新收入 ICU 的决定以及这些决定是如何做出的。医务人员对非再入院的重要性进行了评估。
共有 167 名医生同意参与，其中 58 个 ICU 的 165 名（99%）实际返回了完整的问卷。45%的人年龄<35 岁，74%是全职医生。研究结果表明，非再入院的决定是在患者住院结束时做出的（87%），采用集体决策程序（89%的情况下）；93%的人报告说，这一决定记录在患者的病历中。虽然 73%的人表示已经将非再入院的决定告知了家属/亲属，但只有 29%的人报告告知了患者，91%的人认为非再入院的决定是法国立法框架的一个组成部分。
这项研究表明，需要正式确定不再将患者收入 ICU 的决定，并通过让患者和家属参与讨论，以及其他通常照顾患者的医疗保健提供者，提前做出这一决定。根据每个患者的个体特征，可能需要根据具体情况来决定进行这些对话的最佳时间。
