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KEY POINTS

  • The clinical practice and science of critical care has emerged as a mature multidisciplinary medical specialty but access to critical care—trained clinicians—remains highly variable and inconsistent.

  • Excellence in team-based care and leadership requires specific training and skills to be most effective. Clinical mastery alone is insufficient to deliver outstanding care and should be enhanced with skills in organizational leadership and interpersonal communication.

  • Pathophysiologically informed diagnosis and treatment is the cornerstone of excellent critical care. Incorporating human factors and principles of behavioral economics into critical care organization and clinical decision-making enhances reliability and consistency in the delivery of high-quality care.

  • Critical care resides at the intersection of personal and public health and requires humble and fastidious stewardship of scarce resources to ensure equitable, affordable, and prompt access and reliably high-quality care, including in resource-constrained and developing environments.

  • The care of the critically ill extends beyond the individual patient and requires systems of care that prioritize patient/family centeredness with a focus on continuity of support beyond a critical illness for caregivers of chronically and critically ill patients and the bereaved families and communities of those who die as a consequence of critical illness. Palliative care medicine specialists and experts in behavioral medicine are notable enhancements in care models.

  • Critical care is invigorated by a scholarly approach, involving learning and teaching that incorporates impactful adult learning theories and pedagogical methods, the conduct of hypothesis-based mechanistic, clinical, epidemiological, and qualitative research, and the dissemination of novel findings through a rigorous peer-review process.

THE EMERGENCE OF CRITICAL CARE AS A MATURE MULTIDISCIPLINARY MEDICAL SPECIALTY

The discipline and practice of critical care medicine has evolved as a rigorous, scientifically informed, and highly impactful area of medicine in the first decades of the 21st century. More than 5 million patients annually are admitted to intensive care unit (ICU) in the United States.1 Effective critical care, when optimally designed, is delivered by highly trained, dedicated teams of critical care clinicians, nurses, respiratory, physical, and occupational therapists, pharmacists, nutrition specialists, chaplains, and others who coordinate and collaborate using structured communication and evidence-informed diagnostic and treatment pathways and protocols. Approximately half of 2800 US community hospitals were staffed by privileged intensive care specialists just prior to the COVID-19 pandemic.2,3

There remain significant regional disparities in the global distribution of intensive care–designated hospital beds, averaging 8.73 beds/100,000 prior to the global COVID-19 pandemic but ranging from 6.4 ± 19.5 in lower-income to 12.8 ± 14.6 beds/100,000 in high-income countries.4 Access to critical care services in nonurban and developing areas characterized by resource constraints and scarcity is a significant barrier to equitable, affordable, and timely life-saving critical care. Consistent application of the ethical principles of beneficence, justice, and nonmalfeasance is a pervasive challenge, particularly when reflecting on the disparities in critical care service provision between the postindustrial West and emerging and developing health care settings.

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