Training a hospitalist workforce to address the intensivist shortage in American hospitals

Siegal, Eric; Dressler, Daniel D.; Dichter, Jeffrey R.; Gorman, Mary; Lipsett, Pamela A.

doi:10.1097/ccm.0b013e318258eef7

Cited by 31 publications

(6 citation statements)

References 22 publications

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“…We excluded emergency medicine and obstetrics and gynecology residency programs given low numbers of critical care fellows originating from these programs. (24) We also excluded combined internal medicine/emergency medicine/critical care training programs due to low numbers (<15 fellows in each of the ten years examined). Finally, we did not include neuro-critical care fellows because these fellowships are not ACGME-accredited and we were not able to find published data on neurocritical care fellow demographics.…”

Section: Methodsmentioning

confidence: 99%

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Diversity in the Emerging Critical Care Workforce: Analysis of Demographic Trends in Critical Care Fellows From 2004 to 2014

Lane‐Fall¹,

Miano

Aysola

et al. 2017

Critical Care Medicine

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Objective Diversity in the physician workforce is essential to providing culturally effective care. In critical care, despite the high stakes and frequency with which cultural concerns arise, it is unknown whether physician diversity reflects that of critically ill patients. We sought to characterize demographic trends in critical care fellows, who represent the emerging intensivist workforce. Design We used published data to create logistic regression models comparing annual trends in the representation of women and racial/ethnic groups across critical care fellowship types. Setting United States Accreditation Council on Graduate Medical Education (ACGME)-approved residency and fellowship training programs. Participants Residents and fellows employed by ACGME-accredited training programs from 2004 to 2014. Interventions None. Measurements and Main Results From 2004–14, the number of critical care (CC) fellows increased annually, up 54.1% from 1,606 in 2004–05 to 2,475 in 2013–14. The proportion of female CC fellows increased from 29.5% (2004–05) to 38.3% (2013–14) (p<0.001). The absolute number of black fellows increased each year but the percentage change was not statistically significantly different (5.1% in 2004–05 vs. 3.9% in 2013–14 (p=0.92)). Hispanic fellows increased in number from 124 (7.7%) in 2004–05 to 216 (8.4%) in 2013–14 (p=0.015). The number of American Indian/Alaskan Native/Native Hawaiian/Pacific Islander fellows decreased from 15 (1.0%) to 7 (0.3%) (p<0.001). When compared to population estimates, female CC fellows and those from racial/ethnic minorities were under-represented in all years. Conclusions The demographics of the emerging critical care physician workforce reflect under-representation of women and racial/ethnic minorities. Trends highlight increases in women and Hispanics and stable or decreasing representation of non-Hispanic underrepresented minority CC fellows. Further research is needed to elucidate the reasons underlying persistent under-representation of racial and ethnic minorities in critical care fellowship programs.

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Section: Methodsmentioning

confidence: 99%

“…We excluded emergency medicine and obstetrics and gynecology residency programs given low numbers of critical care fellows originating from these programs. (24) We excluded combined internal medicine/emergency medicine/critical care training programs due to low numbers (<15 fellows in each of the ten years examined).…”

Section: Methodsmentioning

confidence: 99%

Diversity in the Emerging Critical Care Workforce: Analysis of Demographic Trends in Critical Care Fellows From 2004 to 2014

Lane‐Fall¹,

Miano

Aysola

et al. 2017

Critical Care Medicine

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“…[3][4][5][6][7] Intensivist staffing is needed for the care of the critically ill, but the nationwide shortage has led hospitals to explore alternative solutions. 2,[8][9][10][11][12][13] The intensivist shortage has also become a factor when choosing between various models. 5,[8][9][10][11] There is mounting evidence that the 24/7 intensivist coverage models may not improve outcomes better than traditional daytime high-intensity staffing models to justify the additional cost.…”

Section: Introductionmentioning

confidence: 99%

“…2,[8][9][10][11][12][13] The intensivist shortage has also become a factor when choosing between various models. 5,[8][9][10][11] There is mounting evidence that the 24/7 intensivist coverage models may not improve outcomes better than traditional daytime high-intensity staffing models to justify the additional cost. Also, the literature does not support incremental gains from adding a nighttime intensivist to high-intensity daytime intensivist coverage.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Implementing an Intensivist Model With Nighttime In-Hospital Nocturnist and Effect on ICU Outcomes

Tanios

Teres

Park

et al. 2018

J Intensive Care Med

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“…Overall, it can be suggested that a closed format staffing is preferable above a traditional ICU staffing. In line with this, the Critical Care Societies recommend the closed format above the “open format.” Although it is recommended, the closed format is still not implemented widely which may be caused by a shortage of intensivists [12, 13]. …”

Section: Introductionmentioning

confidence: 99%

The impact of changes in intensive care organization on patient outcome and cost-effectiveness—a narrative review

et al. 2017

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The mortality rate of critically ill patients is high and the cost of the intensive (ICU) department is among the highest within the health-care industry. The cost will continue to increase because of the aging population in the western world. In the present review, we will discuss the impact of changes in ICU department organization on patient outcome and cost-effectiveness. The general perception that drug and treatment discoveries are the main drivers behind improved patient outcome within the health-care industry is in general not true. This is especially the case for the ICU department, in which the past decades’ organizational changes were the main drivers behind the reduction of ICU mortality. These interventions were at the same time able to reduce cost, something which is rare for drug and treatment discoveries. The organization of the intensive care department has been changed over the past decades, resulting in better patient outcome and reduction of cost. Major changes are the implementation of the “closed format” and electronic patient record. Furthermore, we will present possible future options to improve the organization of the ICU department to further reduce mortality and cost such as pooling of dedicated ICU into mixed ICU and embedding business strategies such as lean and total quality management. Challenges are ahead as the ICU is taking up the largest share of national health-care expenditure, and with the aging of the population, this will continue to increase. Besides future improvements of organizational structures within the ICU, the focus should also be on the implementation of and compliance with proven beneficial organizational structures.

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Training a hospitalist workforce to address the intensivist shortage in American hospitals

Cited by 31 publications

References 22 publications

Diversity in the Emerging Critical Care Workforce: Analysis of Demographic Trends in Critical Care Fellows From 2004 to 2014

Diversity in the Emerging Critical Care Workforce: Analysis of Demographic Trends in Critical Care Fellows From 2004 to 2014

The Impact of Implementing an Intensivist Model With Nighttime In-Hospital Nocturnist and Effect on ICU Outcomes

The impact of changes in intensive care organization on patient outcome and cost-effectiveness—a narrative review

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