Intensive care triage in Australia and New Zealand

To compare the attitudes towards common intensive care triage scenarios in New Zealand and Australia and to evaluate Australasian intensive care triage practice.

A web-based survey of Australian and New Zealand intensive care doctors measuring demographics, details of recent triage decisions and attitudes towards various triage scenarios.

A total of 238 responses were obtained (32.6% response rate). The mean number of triage decisions was 6.3 per clinician per week in New Zealand (95%CI 4.6-8.0) and 8.5 per week in Australia (95% CI 6.6-10.4) (test for difference in means, p=0.08). The mean rate of refusal for the week prior to the survey was 30.8% (95%CI 19.5-42.1) among New Zealand respondents and 25.1% (95% CI 19.7-30.4) among Australian respondents (test for difference in proportions, p=0.35). Australian respondents were more likely than New Zealand respondents to agree that it was appropriate to admit a patient: - with a non-survivable brain injury who may progress to brain death (p=0.0001); - with acute respiratory distress syndrome in the setting of relapsed acute myeloid leukaemia (p=0.0005); - in a persistent vegetative state with pneumonia due to malposition of a feeding tube (p=0.03); However, there were no differences found between Australian and New Zealand respondents on the appropriateness of admitting a patient: - in a persistent vegetative state with pneumonia with a non-iatrogenic cause (p=0.58); - with an infective exacerbation of chronic obstructive pulmonary disease with a background of functional impairment (p=0.060); - of an advanced age who is unable to extubate due to drowsiness and hypoventilation following a laproscopic hernia repair (p=1.00); - suffering from a massive stroke, intubated in a crowded emergency department, but now needing extubation and palliation (p=1.00).

New Zealand doctors have more selective views of what constitutes an appropriate admission to intensive care.