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KEY POINTS

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KEY POINTS

  1. The organization and management of critical care services are key to ICU performance and may impact patient outcomes and healthcare costs.

  2. Critical care organizations with advanced governance offer several benefits including unifying all ICUs under one leadership with defined accountability; improved opportunities to reduce costs; standardization of technologies across ICUs; enhanced crtical care research; and improved retention of faculty through a more stale environment.

  3. Movement toward unification of governance commences with the education of intensivists during their fellowship training.

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INTRODUCTION

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Critical care medicine (CCM) has made significant strides since its inception as a unique specialty almost 50 years ago. In the United States, the use and costs of CCM continues to rise. Between 2000 and 2010, critical care beds increased 17.8% (88,235-103,900) in nearly 3000 acute care hospitals with intensive care unit (ICU) beds. In 2010, critical care in the United States accounted for 13.2% of hospital costs, 4.1% of national health expenditures, and 0.74% ($108 billion) of the gross domestic product.1 As critical care consumes significant portion of hospital beds and resources and plays a major role in throughput of emergency departments and operating rooms, it is of vital interest to hospital leadership to unify, standardize, and control this resource.

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In response to the perceived shortage of trained intensivists in the United States,2 proposals to mitigate this shortfall have been developed including tiered regionalization of critical care services3 and providing alternative coverage options with hospitalists,4 advance practice providers (nurse practitioners and physician assistants),5 and ICU telemedicine in community hospitals.6

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In recent years, there has been an increasing tendency for critical care services in academic medical centers to consolidate their staffing and resources, and to form advanced governance organizations, above the level of departmental divisions or sections.7 The designation varies greatly from service lines, systems, signature programs, centers, institutes, and clinical departments. To date, only one academic university department of critical care exists in North America at the University of Pittsburgh. Introduction of service line models to critical care, mandates to improve quality and safety of healthcare,8,9 and transparent public disclosure have added momentum to the health care industry recognizing the need for well-governed critical care as an important tool in business management of medical centers. Among the many aspects that need unified critical care governance include patient management, protocol institution, technology acquisition, education, training, and interactions with other hospital areas.

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ORGANIZATION AND MANAGEMENT OF CRITICAL CARE SERVICES

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The organization and management of critical care services are key components that contribute to ICU performance and may impact patient outcomes and health care costs. The guidelines for critical care delivery, clinical roles, and best practice model in the ICU from the Society of Critical Care Medicine published in 2001 and updated in 2015 are excellent resources for how ICUs should ...

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