Decision Making Part 1

Danny Bryden, Dale Gardiner

In the first part of this series, Danny Bryden and Dale Gardiner give their views on decision making, particularly with respect to admission to critical care. They also discuss wellbeing, and the impact of COVID-19. Danny is vice dean of the FICM. Dale is a consultant in anaesthesia and ICM in Nottingham, and is the national clinical lead for organ donation with an interest in medical ethics.

In this podcast, Danny Bryden talks about good practice in decision making when considering admission to critical care.

Flaatten H, De Lange DW, Morandi A, et al. The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years). Intensive Care Med. 2017;43:1820-1828

Bagshaw SM, Stelfox HT, McDermid RC, et al. Association between frailty and short- and long-term outcomes among critically ill patients: a multicentre prospective cohort study. CMAJ. 2014; 186(2):E95-102

COVID-19 rapid guideline: critical care in adults. NICE. March 2020

Mulley A, Trimble C, Elwy G. Patients’ preference matters: Stop the silent misdiagnosis. The King’s Fund 2012.

Specialised Clinical Frailty Network

Danny then talks about admission decision making with reference to the COVID-19 pandemic and also how to maintain wellbeing.

Finally in this series, Dale Gardiner introduces the MORAL balance framework and describes its use in decision making around admission to critical care.

Harvey D, Gardiner D. ‘Moral balance’ decision-making in critical care. BJA Education. 2019;3:68-73.

Kubler-Ross model