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A crisis in critical care

July 2018

Published in the July 2018 issue of Today’s Hospitalist

DO YOU SERVE as a de facto intensivist in your hospital? And if the answer to that question is “yes,” how comfortable are you in that role?

As our cover story reports, hospitalists everywhere are under pressure to take care of ICU patients, no matter how qualified they may feel to do so. That isn’t exactly a new trend. Our 2017 survey, for example, found that two-thirds of hospitalists reported working in their hospital’s ICU, and about half said they serve as an ICU attending.

But according to a recent survey, many hospitalists feel they’re not particularly well-prepared to work as “hospitensivists.” And as our cover story points out, hospitalists’ real or perceived lack of skills in the ICU has real effects on patient care.

Some hospitalists transfer ICU patients to other facilities on weekends, when they have no intensivist back-up. In many cases, transfer centers are either full with no beds, or they are so nonresponsive that hospitalists end up spending hours on the phone trying to find help.

What’s the solution? Having considerably more well-trained intensivists to fill the gap isn’t likely to happen in the near future. Tele-ICUs are helping some hospitalists manage the critical care load, but they’re only part of the solution.

Perhaps most encouraging is that some hospitalists, even those in rural facilities with little or no access to intensivists, are finding ways to develop skills—and workarounds—that produce the support they need to manage critically ill patients. While those solutions aren’t perfect, they’re what’s working for many hospitalists.

Edward Doyle
Editor & Publisher
edoyle@todayshospitalist.com

 

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Mark Janes
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As a critical care physician, I see hospitalists doing too much. They ask me to see patients much later than before they were available in the hospital. They delay consulting until several days after admission, even when I am very slow in the hospital. Don’t know what the answer is, but in my small rural hospital, delay in care is also a problem that could be averted. I may have 6-7 patients in the hospital and they have 20-30.