Critical care doctors are frequently faced with clinical problems that have important ethical and moral dimensions. While Western attitudes and practice are well documented, little is known of the attitudes or practice of Chinese critical care doctors. An anonymous, written, structured questionnaire survey was translated from previously reported ethical surveys used in Europe and Hong Kong. A snowball method was used to identify 534 potential participants from 21 regions in China. A total of 315 (59%) valid responses were analysed. Most respondents (66%) reported that admission to an intensive care unit (ICU) was commonly limited by bed availability, but most (63%) would admit patients with a poor prognosis to ICU. Only 19% of respondents gave complete information to patients and family, with most providing individually adjusted information, based on prognosis and the recipient’s educational level. Only 28% disclosed all details of an iatrogenic incident, despite 62% stating that they should. The use of do not resuscitate orders or limitation of life-sustaining therapy in terminally ill patients reported as uncommon and according to comparable reports, both are more common practice in Hong Kong or Europe. In contrast to European practices, doctors were more acquiescent to families in decision-making at the end of life. A number of differences in ethical attitudes and related behaviour between Chinese, Hong Kong and European ICU doctors were documented. A likely explanation is differing cultural background, and doctors should be aware of likely expectations when treating patients from a different culture.

Attitudes towards ethical problems in critical care medicine: the Chinese perspective

Critical care medicine began in mainland China in the early 1980s. After almost 30 years of effort, it has been recognized as a specialty very recently. However, limited data suggest that critical care resources, especially ICU beds, are inadequate compared with those of developed countries. National critical care societies work together to set up good practice standards, and to improve academic levels with scientific meetings, education programs, and training courses. Critical care research in mainland China is beginning to evolve, with great potential for improvement.

/pdf/clinical-review-critical-care-medicine-in-mainland-china-wan1s3ir37.pdf

Clinical review: Critical care medicine in mainland China

Objectives Data about the critical care resources in China remain scarce. The purpose of this study was to investigate the variation and distribution of critical care resources in Guangdong province from 2005 to 2015. Design Data in regard to critical care resources were collected through questionnaires and visits every 5 years from 2005. Setting All hospitals in Guangdong province were screened and hospitals that provide critical care services were enrolled. Intervention None. Measurements and main results One hundred eleven, 158, and 284 hospitals that provide critical care services were enrolled in the three consecutive surveys respectively. The number of ICUs, ICU beds, intensivists, and nurses increased to 324, 3,956, 2,470, and 7,695, respectively, by 2015. Adjusted by population, the number of ICU beds per 100,000 (100,000) population increased by 147.7% from 2005 to 2015, and the number of intensivists and nurses per 100,000 population increased by 35.3% and 55.1% from 2011 to 2015. However, the numbers in the Pearl River Delta, a richer area, were higher than those in the non-Pearl River Delta area (ICU beds: 4.64 vs 2.58; intensivists: 2.90 vs 1.61; nurses: 9.30 vs 4.71 in 2015). In terms of staff training, only 17.85% of intensivists and 14.29% of nurses have completed a formal accredited critical care training program by 2015. Conclusions Our study was the first one to investigate the trend and distribution of critical care resources in China. The quantity of ICU beds and staff has been increasing rapidly, but professional training for staff was inadequate. The distribution of critical care resources was unbalanced. Our study can be beneficial for healthcare policymaking and the allocation of critical care resources in Guangdong province and other provinces in China.

Critical Care Resources in Guangdong Province of China: Three Surveys from 2005 to 2015.

目的 调查北京市重症监护病房的种类、床位、人员配备和管理模式.方法 对64家医院的126个ICU,就床位设置、人员配备及管理模式进行问卷调查.结果 64家医院平均拥有1.97个ICU;平均每个ICU拥有病床8.7张;综合性ICU与专科ICU的数量及病床数相当;医生∶护士∶总床位=0.70∶1.71∶1.00;综合性ICU、呼吸ICU和儿科ICU人员配备相对其他专科ICU充足;57.9%的ICU有专职主任.结论 北京市大中型医院基本均设有ICU病房,其性质为综合性与专科性并存,ICU管理模式多样,床位及人员配备既相对不足,又存在低水平重复配置的浪费.ICU应严格"进出"标准,遵循循证医学原则,控制费用,避免过度医疗和高额医疗费用。

Investigation on establishment and management of intensive care units in 64 hospitals in Beijing

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Investigation on establishment and management of intensive care units in 64 hospitals in Beijing