ICU bed allocation: clinicians prioritize "rescuing" a critically ill patient over societal benefit
Allocating intensive care unit (ICU) beds can be challenging, particularly when the unit is nearly full. If there is one bed left, should it go to a gravely ill patient who wants to prolong life but has little chance of survival, or should the bed be given to a deceased or dying patient who could help others by donating organs? This is the question researchers recently asked critical care clinicians. According to their findings, physicians are more likely than nurses to give the last bed to the gravely ill patient in attempts to "rescue" them.
The questionnaires forced respondents to choose to give the final ICU bed to one of two patients. The first was a cancer patient for whom admission to the ICU was unlikely to change the course of survival with an already poor prognosis. The second was a patient arriving at the hospital after suffering cardiac arrest with non-recoverable brain injury for whom admission to the ICU would allow him to be an organ donor. Those surveyed received 1 set of 2 scenarios out of 4 possible pairs that differed in the social benefit of 5 versus 30 extra years of life to be gained by others from potential organ donation in addition to whether or not the organ donor was brain dead. Physicians and nurses were also asked about their perceptions of organ donation and conflicts of interest during end-of-life care.
The researchers received completed responses from 684 physicians and 438 nurses. A higher percentage of physicians (45.9 percent) selected the cancer patient for the last ICU bed compared to nurses (32.6 percent). Clinicians were less likely to allocate the last ICU bed to the cancer patient when the organ donation case offered 30 life-years compared to 5 life-years. The majority of physicians (65 percent) and nurses (75 percent) stated strong obligations to identifiable living patients when it came to ICU bed allocation, often termed the "rule of rescue" by researchers. The study was supported in part by AHRQ (HS18406).
See "Rule of rescue or the good of the many? An analysis of physicians’ and nurses’ preferences for allocating ICU beds," by Rachel Kohn, B.A., Gordon D. Rubenfeld, M.D., M.Sc., Mitchell M. Levy, M.D., and others in Intensive Care Medicine 37, pp. 1210-1217, 2011.