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The ICUPASS study: variability, influencing factors, and clinician stress in ICU admission decisions
Chacko, Cyril Kanna, Girish Devasar, Shaveta Sharma, Amit Fisher, Thomas Pooni, Jagatar S. Macduff, Andrew Gopal, Shameer Dhamodaran, Kesaven
Chacko, Cyril
Kanna, Girish
Devasar, Shaveta
Sharma, Amit
Fisher, Thomas
Pooni, Jagatar S.
Macduff, Andrew
Gopal, Shameer
Dhamodaran, Kesaven
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Epub Date
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2026-06-18
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Abstract
Objectives
The objectives of this study were to quantify the variability in intensive care unit (ICU) admission decisions, identify influencing factors, and measure the associated stress among different groups of healthcare professionals.
Design
This was a cross-sectional survey using 10 standardised clinical vignettes.
Setting
The study was conducted in ICUs in the West Midlands, UK.
Participants
The study included 84 ICU professionals, categorised as decision-makers ([DMs] consultants and senior registrars, n=47) or non-decision-makers ([NDMs] other clinical staff, n=37).
Main outcome measures
For each vignette, respondents rated the likelihood of admission, associated stress, and likelihood of admission with unlimited resources on a 10-point Likert scale. The primary reason for non-admission was also selected.
Results
Admission likelihood was heterogeneous across all vignettes (median 5, IQR 6), with no significant difference between DMs and NDMs. DMs reported significantly lower stress than NDMs (median 4 vs 5, p<0.001). Clinically ambiguous vignettes showed the highest variability and stress. Counterintuitively, admission likelihood was significantly lower under a hypothetical unlimited-resources scenario (median 3 vs 5, p<0.001). "Futility" was the most common reason cited for non-admission.
Conclusions
Substantial variability and stress are inherent to ICU admission decisions, even among experienced clinicians. Subjective clinician factors shape decisions alongside objective patient data, underscoring the need for decision-support tools in ambiguous cases and strategies to ease the psychological burden on clinical staff.
Citation
Chacko C, Kanna G, Devasar S, et al. (2026) The ICUPASS Study: Variability, Influencing Factors, and Clinician Stress in ICU Admission Decisions. Cureus 18(6): e111068. doi:10.7759/cureus.111068
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Journal article
Language
en
Description
© 2026 The Authors. Published by Springer. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.7759/cureus.111068
Series/Report no.
ISSN
2168-8184