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Why do we continually ask "Do we need intensivists"?
| Content Provider | Semantic Scholar |
|---|---|
| Author | Worthley, Lindsay I. G. |
| Copyright Year | 2000 |
| Abstract | I know of no other discipline that consistently reviews its practice with and without specialists. Cardiologists, nephrologists, thoracic physicians, etc, go about their business with the understanding that theirs is a specialty that requires an appropriately trained and experienced individual before an excellence in care (and we assume a reduction in patient morbidity and mortality) can be provided. Yet intensivists continually provide evidence that their specialty is relevant and that training is important if a reduction in morbidity and mortality for critically ill patients, and decreased cost in running the intensive care unit are to be achieved. In one recent multi-centre study, daily rounds by an intensivist were associated with a three fold reduction in in-hospital mortality in abdominal aortic surgery patients, implying that a hospital could be negligent if it allowed major vascular surgery to be performed without providing postoperative care by an intensivist in an intensive care unit. Early in the genesis of the specialty of critical care medicine in the United States of America it was believed that “no one person can become competent in all aspects of critical care”. However, this is probably true of any specialty. Yet this common wisdom along with an editorial “concern” with the concept that “critical care service should be provided by full time physicians who assume primary responsibility for patient care”, implied that an 'open' format intensive care unit (i.e. where the admitting clinician dictated management) was the preferred model. In the United Kingdom, an Inter-Faculty Collegiate Liaison Group on Intensive Therapy took a stronger stand by stating that it “does not recommend the emergence of the 'Intensivist' as a separate specialist, but considers that consultants with a special interest in intensive therapy would also pursue a clinical career in their parent specialty (anaesthesia, medicine or surgery)”. From the beginning in Australia and New Zealand a 'closed' format intensive care unit (i.e. where the resident intensivist dictated management) became the predominant working model. Specialists from either anaesthesia or internal medicine (or both) functioned as the 'intensivist'. From 1980, Intensive Care Medicine became a sectional specialty of the principal specialties Anaesthetics and Internal Medicine, and both the Royal Australasian College of Physicians and the Faculty of Anaesthetists, Royal Australasian College of Surgeons developed their own training schemes. Currently, the administrative issues of training are changing and it appears that a single Australasian body for certification in Intensive Care Medicine will soon become a reality. While intensive care units do not have a standard administrative structure (due to regional differences in hospital services), the issue concerning the need for an intensivist has now became clear. Intensive care units that have a 'closed' format have a lower morbidity and mortality when compared with intensive care units that have an 'open' format. The data are compelling; hospitals that manage critically ill patients need intensivists if they are in the business of reducing morbidity, mortality and costs. |
| File Format | PDF HTM / HTML |
| PubMed reference number | 16597306 |
| Journal | Medline |
| Volume Number | 2 |
| Issue Number | 4 |
| Alternate Webpage(s) | https://www.cicm.org.au/CICM_Media/CICMSite/CICM-Website/Resources/Publications/CCR%20Journal/Previous%20Editions/December%202000/02_2000_Dec_Editorials.pdf |
| Journal | Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
