Table 5.
Main comments from physicians in the focus groups
| The medical dilemma |
| U2: … there is a patient, “Mr. X,” outside of the hospital with “this and that” and he needs the ICU. I have three “Mr. Xs” just in here at the ER. And my “Mr. X” is younger. My problem is here, not there. |
| E4: “He would benefit from the ICU, and I have already asked for his admission. But he will have to wait for ICU bed availability”. This is my speech to the family. |
| E5: “I lose the patient” because there is no ICU bed available. |
| U2: ...we are afraid to discharge the patient from the ICU. Here at the ICU, we have a multidisciplinary team that is better than the outside. |
| E5: The nurse usually asks us to choose. She says: “Doctor. There are 3 patients and just one bed available. Whom do you give priority?” |
| U5: I don’t care who comes to the ICU. I think the CER regulates the patients. They will decide. I must admit the patient, prescribe, treat him and discharge him quickly. |
| U2: The CER should have a kind of a “Superman telephone”. I don’t need the hospital director involved with ICU patients admissions. I need a CER with some empowerment to say: “I have a patient with a life-threating condition, and I need to take him to the ER. And then he would be visible to the ICU staff. |
| E4: I exchange messages by WhatsApp. |
| U2: The chief doctor from the ER says: “I have a decompensated patient with diabetes.” That’s how it works. |
| The failure in access |
| U3: Our worst enemy is an inadequate indication for the ICU. Suppose there is an elderly patient with a nonreversible neurologic disease. The ER colleague thinks that he needs ICU just because he is on mechanical ventilation. |
| E4: All patients with a higher risk of death have the right to be admitted to the ICU. I think that the criteria should be first come, first served. |
| E5: No. We don’t have protocols for ICU admission. |
| U1: Sometimes the patient leaves the ICU and returns very quickly. He has just arrived at the general ward and hasn’t even “warmed up” the bed when he develops a retained airway secretion, and nobody was able to help him. |
| U2: The queue is not unique. I also have the demands from the hospital, like the surgical patients... they compete. |
| E1: The problem is the number of nurses outside the ICU. They must give medicines, feed the patients, turn them every 2 hours. How can they offer good care? |
| U3: There are no oxygen therapy devices in the general ward. How can we discharge patients from the ICU? |
| U4: Usually, there are few nursing beds for admitting patients after ICU discharge. I think this is the most important reason for patients’ prolonged length of stay. |
| E1: A patient’s family asks for a medical report. It must be written that he is at risk of death and he needs the ICU. And the judge determines his admission to any available ICU. |
| The societal drama |
| E1: “The queue will explode”! |
| E1: (The queue) happens because there are no ICU beds available. It’s a shame. Only nine ICU beds in a hospital that is a referral source for the Olympic games! |
| E4: It is not only the lack of ICU beds. ...if you don’t invest in primary care and public safety. It is cheaper to treat hypertension and diabetes instead of cerebral vascular disease. |
| E1: He is a nobody, and I nominate him to the ICU to become somebody. |
| E1: ... every day we admit a patient who has been shot… every day. People crashing into violent traffic. An amazing number of motorcyclists. It won’t solve the problem creating more ICU beds if there is not a decline in what makes them need to come here. |
| U4: if we could bring this line to the hospital... we'd have to deal with only one part of the problem: Which one will benefit from the ICU? Patients must go to the ER, be first evaluated, and then go to surgery, or have a computed tomography scan or go to the ICU." |
ICU - intensive care unit; ER - emergency room.