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Managing Critically Ill Surgery Patients

Managing Critically Ill Surgery Patients

Staff shortages for sur­geons and intensivists can make it challenging for hospitals to optimize the care of critically ill and injured surgical patients. “Although critical care and surgery have made tremendous advances during the past 50 years, these advances have led to greater subspecialization,” says Samuel A. Tisherman, MD. “This has discouraged many surgeons from including critical care as a principal component of their practice.” Broadening Training In a white paper published in JAMA Surgery, Dr. Tisherman and colleagues presented recommendations for broadening multidisciplinary training and practice opportunities in surgical critical care for intensivists. The article also offered guidance for maintaining a 24/7 intensivist model. In this model, all intensivists—regardless of their base specialty—must be appropriately trained, credentialed, and dedicated to critical care and give undivided attention to critically ill patients. Dr. Tisherman and colleagues encouraged several approaches to assure adequate staffing in order to provide intensivist coverage of critically ill or injured surgical patients: – Mechanisms should be in place for physicians from multiple disciplines to be educated in surgical critical care, to enroll in accredited surgical critical care fellowship programs, and to receive full certification. – Organizational support is needed to develop common critical care training programs and credentialing with other specialties that offer these certifications. – Hospitals and surgical departments should recognize that intensivists whose primary specialty is not surgery are necessary to provide patients with high-level surgical critical care. – All intensivists should dedicate time to the ICU without other concurrent obligations. The amount of time devoted to surgical critical care within training programs should not be shortened or diluted. Critical care coverage must be...
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