Surgeon-reported conflict with intensivists about postoperative goals of care.

Paul Olson TJ, Brasel KJ, Redmann AJ, Alexander GC, Schwarze ML.

Source

Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA.

Abstract

OBJECTIVE:

To examine surgeons' experiences of conflict with intensivists and nurses about goals of care for their postoperative patients.

DESIGN:

Cross-sectional incentivized US mail-based survey.

SETTING:

Private and academic surgical practices.

PARTICIPANTS:

A total of 2100 vascular, neurologic, and cardiothoracic surgeons.

MAIN OUTCOME MEASURES:

Surgeon-reported rates of conflict with intensivists and nurses about goals of care for patients with poor postsurgical outcomes.

RESULTS:

The adjusted response rate was 55.6%. Forty-three percent of surgeons reported sometimes or always experiencing conflict about postoperative goals of care with intensivists, and 43% reported conflict with nurses. Younger surgeons reported higher rates of conflict than older surgeons with both intensivists (57% vs 32%; P = .001) and nurses (48% vs 33%; P = .001). Surgeons practicing in closed intensive care units reported more frequent conflict than those practicing in open intensive care units (60% vs 41%; P = .005). On multivariate analysis, the odds of reporting conflict with intensivists were 2.5 times higher for surgeons with fewer years of experience compared with their older colleagues (odds ratio, 2.5; 95% CI, 1.6-3.8) and 70% higher for reporting conflict with nurses (odds ratio, 1.7; 95% CI, 1.1-2.6). The odds of reporting conflict with intensivists about goals of postoperative care were 40% lower for surgeons who primarily managed their intensive care unit patients than for those who worked in a closed unit (odds ratio, 0.60; 95% CI, 0.40-0.96).

CONCLUSIONS:

Surgeons regularly experience conflict with critical care clinicians about goals of care for patients with poor postoperative outcomes. Higher rates of conflict are associated with less experience and working in a closed intensive care unit.