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Table 4 Ethical problems related to ICU discharge

From: Ethical problems in intensive care unit admission and discharge decisions: a qualitative study among physicians and nurses in the Netherlands

Problem Participant Representative quotes
Premature/suboptimal discharge General ward nurse “We as a general ward think beforehand - ‘we cannot give that care’ and the ICU thinks - ’that should absolutely be possible’. I do get it from an ICU point of view, but you just don’t realize what it sometimes means at a general ward. Of course we can give noradrenalin, we know how that works, and we can give certain medications and whatever, but during the nightshift I have fifteen other patients and I can’t be by that bedside every ten minutes. That’s the problem. That’s something we talk about, argue about quite regularly”.
  General ward nurse “We have those borderline cases where you think - we can do it, but it’s almost impossible at our ward, because we can’t check up on those people that often. And we don’t have monitoring, so it’s not like an alarm sounds when things suddenly turn south. And you just have a number of other patients, that is sometimes the problem. It’s not really a matter of being able or allowed to do something, but you just can’t handle it because you have so many other patients and then it’s just irresponsible to have them lie in the ward without monitoring”.
  ICU nurse “Medically speaking the patient is actually well enough to go to the general or the medium care ward, but those wards say: ‘guys, we can’t handle that one. It’s just impossible!’ And sometimes that’s accepted and usually it isn’t. Usually it’s like - ’well, not my problem. Needs to be admitted anyway’.”