A Research On The Issue Of ICU-detained Therapy For Cerebral Stroke Patient With Consciousness Disturbance

With the aging of population in China,cerebral stroke has become a common and frequently occurring disease,and the consciousness-disturbance cerebral stroke(CDCS)is a special type.The therapy of CDCS is a long-term complicated process and can be divided into three different stages: acute phase in intensive care unit(ICU)admission,recovery from disturbance of consciousness,and neurological rehabilitation.“ICU-detained therapy”(IDT)is frequently observed among the CDCS patients following their acute phase therapy in ICU.However,the systematic research and relevant ethics analysis on above issue are less conducted in the field of hospital administration with little attention.From January 1st 2015 to December 31 st 2016,medical data of 108 CDCS patients treated at four hospitals in Qingdao area were retrospectively reviewed.Out of these patients,51 cases were identified as the occurrence of ICU-detained therapy.The demographics of above patients and the related parameters on medical costs were abstracted and analyzed for illustrating the general features of IDT in CDCS population.And our results revealed that IDT in CDCS,with an average duration of 36 days and4-fold higher in medical costs than non-IDT,belonged to a passive overtreatment.And the hospital located in urban area had a higher IDT proportion than the hospital in rural area.And the hemorrhagic stroke,70-90 age group,and the patients from rural area were associated with a high IDT proportion.A positive correlation was found between the age of patients and proportion of IDT.In addition,a questionnaire survey focusing on CDCS-IDT was then conducted in ICU doctors,non-ICU doctors,and patient authorized clients.Further,ethics analysis highlighted that the deprived information right by the ICU doctor,the abuse of consent right by the patient authorized clients,and the lost of medical ethics principle in non-ICU doctors due to the ongoing assessment system of hospital administration were all identified as key risk factors that contribute to the IDT in CDCS patients.Finally,our results concluded that CDCS-IDT belonged to a passive-overtreatment phenomenon in the governmental hospital under a hospital administration and assessment system currently in effect.It led to a serious waste of social resources,and deserved special attention.Therefore,an effective and ethical hospital management intervention model should be given to mitigating above risk factors that obstructed the transfer of CDCS patients from ICU to general wards.Utilizing diagnosis related groups(DRGs)payment for CDCS patient in the acute-phase therapy in ICU may prevent or reduce the occurrence of ICU-IDT.