Are Intensivists Safe?
- Gordon D. Rubenfeld, MD, MSc; and
- Derek C. Angus, MD, MPH
- From the University of Toronto, Toronto, Ontario MHN 3M5, Canada, and University of Pittsburgh School of Medicine, Pittsburgh, PA 15261.
Intensivists have an identity problem. We do not perform unique procedures, such as coronary angioplasty or endoscopy. We used to take pride in our skills placing and interpreting data from pulmonary artery catheters, but this art is dying rapidly as the evidence mounts against its utility (1). We do not have an organ focus, as do neurologists or nephrologists. Many of us are internists, but others are pediatricians, anesthesiologists, neurologists, and surgeons. Despite this identity crisis, critical care medicine has not faded into obscurity but rather is enjoying a period of focused attention and popularity. Among the reasons are recent epidemiologic studies that emphasize the burden of critical illness and prominent, if controversial, clinical trials that are finally creating an evidence base for our practice (2–5). Of note, we have attracted the attention of payers and quality assurance agencies, primarily because of studies showing that organized staffing by intensivists improves the outcome of critically ill patients (6–8).
In most of the world, critically ill patients are managed in closed intensive care units (ICUs). Therefore, research about different intensivist staffing models is only possible in and primarily of interest to clinicians in the United States (9). The terminology for models of intensive care physician staffing is not standardized and can be confusing (see Glossary). In the most cited systematic review (7), high-intensity staffing referred to ICUs with policies that require transfer of responsibility for care of every critically ill patient to a single intensivist team (closed ICUs) or that mandate consultation by an intensivist. The high-intensity models evaluated in these studies were based on unit-level policies that reflect an environment of care rather than the individual physician (intensivist or nonintensivist) assigned to the patient. We use the term intensivist staffing to specifically refer to high-intensity models …
This 100-word excerpt has been provided in the absence of an abstract.
Most Read
