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Prevalence and factors of intensive care unit conflicts: the conflicus study.

Elie Azoulay 1 Jean-François Timsit 2 Charles Sprung 3 Marcio Soares 4 Katerina Rusinová 5 Ariane Lafabrie 1 Ricardo Abizanda 6 Mia Svantesson 7 Francesca Rubulotta 8 Bara Ricou 9 Dominique Benoit 10 Daren Heyland 11 Gavin Joynt 12 Adrien Français 13 Paulo Azeivedo-Maia 14 Radoslaw Owczuk 15 Julie Benbenishty 3 Michael de Vita 16 Andreas Valentin 17 Akos Ksomos 18 Simon Cohen 19 Lidija Kompan 20 Kwok Ho 21 Fekri Abroug 22 Anne Kaarlola 23 Herwig Gerlach 24 Theodoros Kyprianou 25 Andrej Michalsen 26 Sylvie Chevret 27 Benoît Schlemmer 1 For The Conflicus Study Investigators And For The Ethics Section of The European Society Of Intensive Care Medicine
Abstract : RATIONALE: Many sources of conflict exist in intensive care units (ICUs). Few studies recorded the prevalence, characteristics, and risk factors for conflicts in ICUs. OBJECTIVES: To record the prevalence, characteristics, and risk factors for conflicts in ICUs. METHODS: One-day cross-sectional survey of ICU clinicians. Data on perceived conflicts in the week before the survey day were obtained from 7,498 ICU staff members (323 ICUs in 24 countries). MEASUREMENTS AND MAIN RESULTS: Conflicts were perceived by 5,268 (71.6%) respondents. Nurse-physician conflicts were the most common (32.6%), followed by conflicts among nurses (27.3%) and staff-relative conflicts (26.6%). The most common conflict-causing behaviors were personal animosity, mistrust, and communication gaps. During end-of-life care, the main sources of perceived conflict were lack of psychological support, absence of staff meetings, and problems with the decision-making process. Conflicts perceived as severe were reported by 3,974 (53%) respondents. Job strain was significantly associated with perceiving conflicts and with greater severity of perceived conflicts. Multivariate analysis identified 15 factors associated with perceived conflicts, of which 6 were potential targets for future intervention: staff working more than 40 h/wk, more than 15 ICU beds, caring for dying patients or providing pre- and postmortem care within the last week, symptom control not ensured jointly by physicians and nurses, and no routine unit-level meetings. CONCLUSIONS: Over 70% of ICU workers reported perceived conflicts, which were often considered severe and were significantly associated with job strain. Workload, inadequate communication, and end-of-life care emerged as important potential targets for improvement.
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Submitted on : Thursday, January 21, 2010 - 10:28:39 AM
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Elie Azoulay, Jean-François Timsit, Charles Sprung, Marcio Soares, Katerina Rusinová, et al.. Prevalence and factors of intensive care unit conflicts: the conflicus study.. American Journal of Respiratory and Critical Care Medicine, American Thoracic Society, 2009, 180 (9), pp.853-60. ⟨10.1164/rccm.200810-1614OC⟩. ⟨inserm-00449257⟩



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