Non-readmission decisions in the intensive care unit under French rules: A nationwide survey of practices

Jean-Philippe Rigaud (1) , Mikhael Giabicani (1) , Nicolas Meunier-Beillard (2, 3, 4) , Fiona Ecarnot (5, 4) , Marion Beuzelin (1) , Antoine Marchalot (1) , Auguste Dargent (2, 4, 6) , Jean-Pierre Quenot (6, 2, 7, 4)

1 Service de Médecine Intensive Réanimation (CH Dieppe)
2 Service de Réanimation Médicale (CHU de Dijon)
3 CGC - Centre Georges Chevrier. Sociétés & Sensibilités [Dijon - UMR7366]
4 UBFC - Université Bourgogne Franche-Comté [COMUE]
5 PCVP / CARDIO - Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920)
6 LIPNESS - Equipe LIPNESS (LNC - U1231)
7 CIC-EC - Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques

Purpose: 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.Materials and methods: 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.Results: 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.Conclusion: 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.

Domaines: Médecine humaine et pathologie; Santé publique et épidémiologie

Jean-Philippe Rigaud, Mikhael Giabicani, Nicolas Meunier-Beillard, Fiona Ecarnot, Marion Beuzelin, et al.. Non-readmission decisions in the intensive care unit under French rules: A nationwide survey of practices. PLoS ONE, 2018, 13 (10), pp.e0205689. ⟨10.1371/journal.pone.0205689⟩. ⟨hal-01915604⟩