Shortage of intensive care specialists in the United States: recent insights and proposed solutions

Pastores, Stephen M.; Kvetan, Vladimír

doi:10.5935/0103-507x.20150002

Cited by 14 publications

(15 citation statements)

References 10 publications

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“…However, we believe it relates to the shortage of intensivists. 11 –13 Community hospitals throughout the country cannot recruit enough intensivists to staff ICUs everyday, despite evidence showing that ICU staffing by intensivists improves patient outcomes, even if they are only present during the daytime. 14 In a systematic review, Pronovost et al demonstrated a ∼30% reduction in relative risk of ICU mortality when ICUs are staffed by “high intensity” intensivists.…”

Section: Discussionmentioning

confidence: 99%

Medical Malpractice Claims Involving Physicians in the Intensive Care Unit: A Cohort Study

Myers

2020

J Intensive Care Med

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Background: The intensive care unit (ICU) is a fast-paced setting, in which physicians from different specialties work. The goal of this study is to understand whether characteristics of medical malpractice claims occurring in the ICU differ by physician specialty. Methods: A retrospective cohort study was performed using a national database called the Comparative Benchmarking System, which is operated by Harvard’s malpractice insurer. Claims were included if the harm events occurred in the ICU and closed between 2007-2016. Claims were analyzed according to physician specialty of the “primary responsible provider,” which was the physician most directly involved in the harm event. Patient-, provider- and claim-level characteristics were compared among the 6 most common physician specialties that were identified as “primary responsible provider.” Multivariable regression was performed to identify factors associated with claim payment. Results: Of 54,772 claims, 1,113 resulted from harm events in the ICU, of which 843 involved the following physician specialties: internal medicine (305), cardiology (163), pulmonary medicine (149), general surgery (98), neurology (97) and anesthesia (31). The minority of claims across physician specialties originated in academic medical centers (<30%). The most common severity of harm was death (Range 42-72%, P = 0.0001). The frequency with which claims involved procedures varied by physician specialty (Range 24-84%, P < 0.0001). The 3 most common contributing factors (patient assessment, selection/management of therapies and communication among providers) did not differ by physician specialty. In multivariable regression, claims that were procedure-related were statistically more likely to result in payment (Odds Ratio 2.29, 95% Confidence Interval 1.64-3.20), after adjusting for physician specialty. Conclusions: There were few unexpected differences in malpractice claims occurring in the ICU by physician specialty. Prevention efforts could focus on procedures, regardless of physician specialty, including: 1) maintaining procedural skills, 2) framing procedural risks well and 3) accurately describing procedural complications after they happen.

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Section: Discussionmentioning

confidence: 99%

Medical Malpractice Claims Involving Physicians in the Intensive Care Unit: A Cohort Study

Myers

2020

J Intensive Care Med

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“…Practicing EM and critical care in private or community settings may mean working for two separate groups (if the hospital does not own both practices). Private practice critical care jobs are increasing in number, and the majority of these jobs will be work in a mixed medical–surgical ICU. While the presence of advanced practice providers (APPs) are increasing in the field of EM and critical care, this demographic of providers is particularly prevalent in the community or private practice setting.…”

Section: Postfellowship Considerationsmentioning

confidence: 99%

Destination Critical Care: A Roadmap for Academic Clinicians, Educators, and Mentors

Hoffman

Mayer

2018

AEM Education and Training

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The purpose of this article is to provide a framework for academic clinicians, educators, and mentors to advise the emergency medicine (EM) resident with an interest in the field of critical care medicine. Prior articles have detailed the prerequisites and specific training curricula of the distinct critical care pathways, but an approach for the advising faculty member in this climate of increased interest in critical care training has yet to be disseminated. In this article, we assume a starting point of EM residency and focus on pivotal training and decision points that occur along the path to matriculation into a critical care fellowship program. These decision points are described in stepwise fashion with aligned questions to help the EM resident evaluate individual strengths and desires that may help the decision-making process. We also describe considerations of the postfellowship job market, as this also plays a role in the fellowship decision-making process.

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“…The COVID-19 pandemic has paved the way necessary for the adaptation of remote care as pressure placed by the pandemic on ICUs worldwide grew to an unparalleled level. The shortage of trained intensivists was further aggravated by the influx of critical patients, prompting facilities to search for creative ways to meet their needs [ 10 ]. Early and widespread utilization of telehealth modalities thankfully offered previously unrealized opportunities to study the various models and examine the results, hear the voices of those who adopted Tele-ICU to their workflow, and learn from their triumphs and failures.…”

Section: Introductionmentioning

confidence: 99%

Telemedicine Intensive Care Unit (Tele-ICU) Implementation During COVID-19: A Scoping Review

Ee¹,

McKelvey²,

Williams³

et al. 2022

Cureus

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Telemedicine intensive care unit (Tele-ICU) programs entail command centers staffed with intensivists and critical care nurses who electronically aid with and deliver real-time information to frontline clinicians. The benefits of Tele-ICU are numerous, but the barriers to it often prove insurmountable, accounting for slow adoption in rural and underserved areas where it is needed the most. Remote monitoring can quickly detect patient deterioration, while consultation provided by a remote intensivist expands the capabilities of smaller facilities. The emergence of the coronavirus disease 2019 (COVID-19) pandemic has brought about a sense of urgency, paving the way for the successful adaptation of tele-intensive care concepts. The goal of this scoping review is to map out the available published data regarding healthcare professionals’ experiences with implementing Tele-ICU modalities during the COVID-19 pandemic. A primary literature search was performed on PubMed/MEDLINE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases from October 2020 to October 2021. Of the 1,083 records screened, 19 were identified as meeting our inclusion criteria and selected for the final scoping review. Five major areas of Tele-ICU use were identified: teleconsultation, telerounding, telemonitoring, family visitation via teleconference, and changing of hospital infrastructure. A heterogeneous mix of improvised Tele-ICU platforms emerged with a common theme of interdisciplinary and family collaboration in the care of critically ill patients. Existing Tele-ICU systems were expanded, and novel programs were launched. A groundbreaking national network in the U.S. (NETCCN) will standardize the deployment of Tele-ICU and expand its reach. Future research should focus on determining accurate costs and the most reliable forms of remote communication, physician compact agreement licensure, the practical composition of Tele-ICU teams, and standardized access to the electronic health record.

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Shortage of intensive care specialists in the United States: recent insights and proposed solutions

Cited by 14 publications

References 10 publications

Medical Malpractice Claims Involving Physicians in the Intensive Care Unit: A Cohort Study

Medical Malpractice Claims Involving Physicians in the Intensive Care Unit: A Cohort Study

Destination Critical Care: A Roadmap for Academic Clinicians, Educators, and Mentors

Telemedicine Intensive Care Unit (Tele-ICU) Implementation During COVID-19: A Scoping Review

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