Factors Influencing the Decision-making of Healthcare Providers Regarding the Transition of Patients from the Intensive Care Unit to the General Ward in Iran: A Qualitative Study

Kobra Ghorbanzadeh; Abbas Ebadi; Mohammadali Hosseini; Sadat Seyed Bagher Maddah; Hamidreza Khankeh; Maryam Khoshbakht Pishkhani; Vahid Adiban

doi:10.5005/jp-journals-10071-24211

Factors Influencing the Decision-making of Healthcare Providers Regarding the Transition of Patients from the Intensive Care Unit to the General Ward in Iran: A Qualitative Study

Indian J Crit Care Med. 2022 May;26(5):568-573. doi: 10.5005/jp-journals-10071-24211.

Authors

Kobra Ghorbanzadeh¹, Abbas Ebadi², Mohammadali Hosseini³, Sadat Seyed Bagher Maddah³, Hamidreza Khankeh⁴, Maryam Khoshbakht Pishkhani⁵, Vahid Adiban⁶

Affiliations

¹ Department of Nursing, Khalkhal University of Medical Sciences, Khalkhal, Iran.
² Department of Behavioral Sciences Research Center, Lifestyle Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
³ Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
⁴ Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Disaster and Emergency Medicine, Karolinska Institute, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.
⁵ Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
⁶ Department of Anesthesiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

Abstract

Background: The process of making decisions to discharge patients from the intensive care unit (ICU) is very complex and risky, and decisions need to be made under time constraints and based on fair allocation of resources. In this situation, decision-making requires team participation, which is often accompanied by tension and conflict between team members and sometimes family members, which in turn affects patient safety and quality of care.

Objectives: The aim of this study was to explore the experiences and perceptions of physicians and nurses regarding the decision-making process in transition of patients from the ICU to the general ward.

Materials and methods: This qualitative study was conducted based on purposive sampling among six nurses and six physicians in Governmental teaching hospitals. The data collection process was conducted from July 2018 to January 2019 through a semistructured interview. Interviews were transcribed and data analysis was accomplished according to the steps proposed by Graneheim and Lundman (2004).

Results: Data analysis revealed six themes that reflected factors influencing decision-making in transition of patients from the ICU to the general ward: contingent decision-making, risky decision-making, lack of coherence in team decision-making, differences in clinical judgment, legal and ethical responsibility, and lack of clear criteria.

Conclusion: The process of decision-making regarding patient transfer from the ICU is a complex and stressful one. It is affected by situations, team participation, clinical judgment skill, legal issues, and multifactorial challenges. To improve decision-making processes, we need to develop abilities and knowledge and design proper interventions to achieve a principled and correct decision-making process.

How to cite this article: Ghorbanzadeh K, Ebadi A, Hosseini M, Maddah SSB, Khankeh H, Pishkhani MK, et al. Factors Influencing the Decision-making of Healthcare Providers Regarding the Transition of Patients from the Intensive Care Unit to the General Ward in Iran: A Qualitative Study. Indian J Crit Care Med 2022;26(5):568-573.

Keywords: Decision-making; Intensive care unit; Patient; Transition.