RT Book, Section
A1 Seymour, Christopher W.
A1 Kahn, Jeremy M.
A2 Oropello, John M.
A2 Pastores, Stephen M.
A2 Kvetan, Vladimir
SR Print(0)
ID 1136412699
T1 Regionalization
T2 Critical Care
YR 1
FD 1
PB McGraw-Hill Education
PP New York, NY
SN 9780071820813
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1136412699
RD 2024/04/18
AB KEY  POINTSRegionalization  refers  to  the  systematic  transfer  of  high-risk  critically  ill  patients  to  regional  referral  centers  where  intensivists  provide  high-intensity  care.Regionalization  has  several  unrealized  benefits  including  the  potential  to  increase  survival  for  critically  ill  patients  through  greater  use  of  evidence-based  practices  and  clinical  experience  with  performing  of  advanced  interventions,  and  shorter  time  to  definitive  therapy.  Concentrating  high-risk,  high-cost  care  for  the  critically  ill  also  has  the  potential  to  reduce  overall  costs  for  the  health  system.Potential  unintended  consequences  include  the  downscaling  of  critical  care  capacity  at  smaller  hospitals  resulting  in  reduced  ability  to  provide  advanced  care  in  emergencies  due  to  an  erosion  of  clinical  skills,  inadequate  equipment,  or  familiarity  of  clinicians  with  best  practice.Regionalization  may  increase  intensive  care  unit  (ICU)  occupancy  or  census  beyond  the  capabilities  of  high-volume  referral  centers  and  may  also  strain  the  capacity  for  interhospital  transport.Barriers  to  implementation  of  regionalization  include  the  lack  of  a  strong  centralized  authority  to  regulate  and  enforce  the  regionalized  system;  strain  on  families  due  to  the  longer  distances  to  travel  for  care  at  referral  hospitals,  lack  of  familiarity  with  physicians/care  team  at  new  hospitals,  and  risks  of  interfacility  transport  to  new  hospital;  capacity  constraints  at  large-volume  hospitals;  and  both  hospitals'  and  physicians'  potential  unwillingness  to  sacrifice  income  when  patients  are  transferred  to  other  hospitals  for  care.Special  challenges  include  the  need  to  educate  new  clinicians  in  understanding  when  patients  should  or  should  not  be  treated  at  referral  hospitals,  balancing  stakeholder  needs,  and  maintaining  patient  centeredness.