Group backs U.S. critical care changes
By JENNIFER C. YATES, Associated Press Writer
Reorganizing the critical care system in the U.S. is the key to dealing with a looming shortage of doctors who specialize in treating critically ill patients, according to one group’s recommendation.
The group â€” which included doctors, patients, insurers, researchers and others â€” believes a tiered, regionalized system for treating critically ill patients would centralize expertise and equipment while also treating the patients most in need.
Dr. Amber E. Barnato, the lead author of the report, said that although the idea of such a system isn’t entirely new, the group’s recommendation is unique.
“It came out of a broad-based consensus process and so it has broad-based support,” said Barnato, an assistant professor at the University of Pittsburgh School of Medicine. “I think we’re in trouble if we don’t take a serious look at it. The current delivery system is just totally untenable.”
Critical care deals with patients who require intensive monitoring in a special unit of a hospital. They are often the most critically ill patients in a hospital.
Last year, the federal Health Resources and Services Administration released a study predicting that the supply of critical care doctors, also known as intensivists, wouldn’t keep pace with the country’s aging population.
The government found that the number of critical care doctors would likely grow from 1,900 to 2,800 between 2000 and 2020. But as many as 4,300 such doctors may be needed by then, according to the government study.
The group’s recommendations are a result of a September 2005 critical care conference and appear in the April issue of the journal Critical Care Medicine.
The conference was sponsored by the American Thoracic Society, the American College of Chest Physicians, the American Association of Critical-Care Nurses and the Society of Critical Care Medicine.
Those groups have recommended a regionalized approach in the past, but the latest report is the first time the idea has also been supported by other groups with a stake in the critical care system, said Dr. David Ingbar, president-elect of the American Thoracic Society.
Dr. John Heffner, the group’s president, said there is a challenge in all medical disciplines to better coordinate care. Regionalizing critical care is one way to do that, he said.
“We do need to increase the workforce, but we do need to think in new and innovative ways,” said Heffner, a critical care doctor at Providence Portland Medical Center and the Oregon Clinic.
The recommendation from the conference was the result of surveys and discussions between doctors, health professionals, insurers and other participants.
Many said organizing critical care facilities similar to how trauma centers are organized â€” with some being for patients with more severe injuries and others for patients in less need â€” might be a good solution.
“It’s efficient,” Barnato said. “You are basically concentrating the scarce resources.”
Organizers of the conference said they hope to meet again to develop a more comprehensive plan for how a regionalized critical care system might operate, including looking into the challenges of moving critically ill patients.