Gatekeeping in Intensive Care

This project started in 2016 with Dr C Bassford from ICM University of Coventry as principal investigator. It is funded by the NIHR Health Service Delivery Research Programme.


About the project


NHS intensive care bed capacity is limited and under constant pressure. This is likely to increase with an ageing population. Admission to an ICU allows critically ill patients access to life-saving treatments but this care involves invasive and distressing interventions.

Given the burdens of therapy on an intensive care unit and the limited prognosis for many critically ill patients, admission to an ICU bed will not be appropriate for all patients. Little is known about how decisions regarding ICU admission are made, or should be made for patients in the NHS. By studying this area of clinical practice a mechanism to improve the quality and consistency of decision-making is developed.​

The project runs in four stages. The first aim is to explore current practice and the experience of key participants. Second, a Discrete Choice Experiment will be conducted to identify preferences of ICU physicians and ICU outreach nurses regarding factors determining a patient’s admission to ICU.

After this, the investigators test a decision support framework to guide clinicians through the decision making process together with a patient and their family. Finally, an evaluation tool for assessing the impact of the decision support framework on decision-making will be tested.