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.”
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 dedicated and free from concurrent operative or outpatient clinical responsibilities. Similar considerations should be applied to research and administrative responsibilities outside the ICU.
Surgical societies should lead the way in promoting training and clinical practice in surgical critical care and acute care surgery. Societies of critical care physicians whose primary training is not in surgery should collaborate with surgical societies in such initiatives.
Providing a Framework
“Academic and administrative leaders should recognize the importance of the intensivist model and provide intensivists with the time and resources they need to assist in the care of critically ill and injured surgical patients,” says Dr. Tisherman. “The perspectives and insights of intensivists can enhance educational and research missions. Intensivists should be encouraged to become educational, investigative, and administrative leaders in surgical critical care. The recommendations in our white paper are not necessarily a solution for the staffing issues that threaten surgical critical care. They do, however, offer the framework for potentially alleviating a significant amount of the burden that hospitals face when providing care to critically ill or injured patients.”
Readings & Resources (click to view)
Tisherman SA, Kaplan L, Gracias VH, et al; Surgery Section, Society of Critical Care Medicine. Providing care for critically ill surgical patients: challenges and recommendations. JAMA Surg. 2013;148:669-674. Available at: http://archsurg.jamanetwork.com/article.aspx?articleid=1690714.
Alam HB, Chipman JG, Luchette FA, Shapiro MJ, Spain DA, CioffiW; Surgical Critical Care Program Directors Society. Training and certification in surgical critical care: a position paper by the Surgical Critical Care Program Directors Society. J Trauma. 2010;69:471-474.
Tisherman SA, Ivy ME, Frangos SG, Kirton OC. Acute care surgery survey: opinions of surgeons about a new training paradigm. Arch Surg. 2011;146:101-106.
Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;288:2151-2162.
Hadzikadic L, Burke PA, Esposito TJ, Agarwal S. Surgical resident perceptions of trauma surgery as a specialty. Arch Surg. 2010;145:445-450.
Esposito TJ, Leon L, Jurkovich GJ. The shape of things to come: results from a national survey of trauma surgeons on issues concerning their future. J Trauma. 2006;60:8-16.