Clinical Momentum in the Intensive Care Unit. A Latent Contributor to Unwanted Care.

ABSTRACT: Many older adults in the United States receive invasive medical care near the end of life, often in an intensive care unit (ICU). However, most older adults report preferences to avoid this type of medical care and to prioritize comfort and quality of life near death. We propose a novel term, "clinical momentum," to describe a system-level, latent, previously unrecognized property of clinical care that may contribute to the provision of unwanted care in the ICU. The example of chronic critical illness illustrates how clinical momentum is generated and propagated during the care of patients with prolonged illness. The ICU is an environment that is generally permissive of intervention, and clinical practice norms and patterns of usual care can promote the accumulation of multiple interventio

SUBMITTER: Kruser JM 

PROVIDER: S-EPMC5427724 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature