Ethical imperatives in staffing and managing a trauma intensive care unit

Abstract

As U.S. trauma surgery evolves to embrace the concept and practice of acute care surgery, the organization and management structure of the intensive care unit must also grow to reflect new challenges and imperatives faced by trauma surgeons. Key issues to be explored in light of acute care surgery include the role of the traumatologist/intensivist in the intensive care unit, as opposed to the traumatologist without specific critical care training, and a potentially expanded role for nonsurgical intensivists as the critical care time available for trauma/intensivists wanes due to increased surgical and non-critical care patient volume. Each of these changes to the practice of trauma/surgical critical care and acute care surgery are evaluated in light of the primacy of appropriately trained intensivists in the critical care unit. The ethics of providing the best care possible is interrogated in light of different service models in both the university and community settings. The roles of residents, fellows, and midlevel practitioners in supporting the goal of the intensivist and the critical care team is similarly explored. A recommendation for an ethical organizational and management structure is presented.

Extremity Injury

“…Surgeons, governments, and academic societies should demand properly designed prospective studies from industry to support their decision making. They should also resist the adoption of new devices until appropriate evidence is available (Terry 2007).…”

Can outcome prediction data change patient outcomes and organizational outcomes?

“…Management and staffing of the ICU is another field to be considered [62,63]. In fact, organizational characteristics have been shown to have wide variability, even in ICUs meeting the 'Leapfrog' standards [64 ], and this suggests room for improvement.…”

Surgical Science and the Evolution of Critical Care Medicine

“…As a result, the specialty of Acute Care Surgery was defined by the American Association for the Surgery of Trauma (AAST) and postresidency Acute Care Surgery fellowship programs were developed to augment existing SCC fellowships (105). Furthermore, the evolution of Acute Care Surgery services without a vast expansion in the clinician pool drove uncertainty around the physician staffing of specialty ICUs, and highlighted the value of nonsurgical intensivist partners, as well as Advanced Practice Providers (APPs), in providing surgical ICU care (106). The first AAST approved Acute Care Surgery fellowship launched in 2008 and has resulted in a steady increase in applicants for SCC certification.…”