Are Intensivists Safe?
Authors: Gordon D. Rubenfeld, Derek C. Angus
Journal: Annals of Internal Medicine (2008)

Editorials3 June 2008Are Intensivists Safe?Gordon D. Rubenfeld, MD, MSc and Derek C. Angus, MD, MPHGordon D. Rubenfeld, MD, MScFrom the University of Toronto, Toronto, Ontario MHN 3M5, Canada, and University of Pittsburgh School of Medicine, Pittsburgh, PA 15261. and Derek C. Angus, MD, MPHFrom the University of Toronto, Toronto, Ontario MHN 3M5, Canada, and University of Pittsburgh School of Medicine, Pittsburgh, PA 15261.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-11-200806030-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Intensivists have an identity problem. We do not perform unique procedures, such as coronary angioplasty or endoscopy. We used to take pride in our skills placing and interpreting data from pulmonary artery catheters, but this art is dying rapidly as the evidence mounts against its utility (1). We do not have an organ focus, as do neurologists or nephrologists. Many of us are internists, but others are pediatricians, anesthesiologists, neurologists, and surgeons. Despite this identity crisis, critical care medicine has not faded into obscurity but rather is enjoying a period of focused attention and popularity. Among the reasons are recent ...References1. Rubenfeld GD, McNamara-Aslin E, Rubinson L. The pulmonary artery catheter, 1967-2007: rest in peace? [Editorial]. JAMA. 2007;298:458-61. [PMID: 17652302] CrossrefMedlineGoogle Scholar2. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303-10. [PMID: 11445675] CrossrefMedlineGoogle Scholar3. Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, et al; Canadian Critical Care Trials Group. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348:683-93. [PMID: 12594312] CrossrefMedlineGoogle Scholar4. Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, et al. Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353:1685-93. [PMID: 16236739] CrossrefMedlineGoogle Scholar5. Van den Berghe G, Wilmer A, Hermans G, Meersseman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354:449-61. [PMID: 16452557] CrossrefMedlineGoogle Scholar6. The Leapfrog Group for Patient Safety. Accessed at www.leapfroggroup.org/for_hospitals/leapfrog_hospital_survey_copy/leapfrog_safety_practices/in_physician_staffing on 2 May 2008. Google Scholar7. Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;288:2151-62. [PMID: 12413375] CrossrefMedlineGoogle Scholar8. Young MP, Birkmeyer JD. Potential reduction in mortality rates using an intensivist model to manage intensive care units. Eff Clin Pract. 2000;3:284-9. [PMID: 11151525] MedlineGoogle Scholar9. Angus DC, Shorr AF, White A, Dremsizov TT, Schmitz RJ, Kelley MA; Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS). Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations. Crit Care Med. 2006;34:1016-24. [PMID: 16505703] CrossrefMedlineGoogle Scholar10. Levy MM, Rapoport J, Lemeshow S, Chalfin DB, Phillips G, Danis M. Association between critical care physician management and patient mortality in the intensive care unit. Ann Intern Med. 2008;148:801-9. LinkGoogle Scholar11. Treggiari MM, Martin DP, Yanez ND, Caldwell E, Hudson LD, Rubenfeld GD. Effect of intensive care unit organizational model and structure on outcomes in patients with acute lung injury. Am J Respir Crit Care Med. 2007;176:685-90. [PMID: 17556721] CrossrefMedlineGoogle Scholar12. Sinuff T, Adhikari NK, Cook DJ, Schünemann HJ, Griffith LE, Rocker G, et al. Mortality predictions in the intensive care unit: comparing physicians with scoring systems. Crit Care Med. 2006;34:878-85. [PMID: 16505667] CrossrefMedlineGoogle Scholar13. Pronovost PJ, Jenckes MW, Dorman T, Garrett E, Breslow MJ, Rosenfeld BA, et al. Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery. JAMA. 1999;281:1310-7. [PMID: 10208147] CrossrefMedlineGoogle Scholar14. Nathens AB, Rivara FP, MacKenzie EJ, Maier RV, Wang J, Egleston B, et al. The impact of an intensivist-model ICU on trauma-related mortality. Ann Surg. 2006;244:545-54. [PMID: 16998363] MedlineGoogle Scholar15. Dimick JB, Pronovost PJ, Heitmiller RF, Lipsett PA. Intensive care unit physician staffing is associated with decreased length of stay, hospital cost, and complications after esophageal resection. Crit Care Med. 2001;29:753-8. [PMID: 11373463] CrossrefMedlineGoogle Scholar16. Diringer MN, Edwards DF. Admission to a neurologic/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage. Crit Care Med. 2001;29:635-40. [PMID: 11373434] CrossrefMedlineGoogle Scholar17. Gajic O, Afessa B, Hanson AC, Krpata T, Yilmaz M, Mohamed SF, et al. Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital. Crit Care Med. 2008;36:36-44. [PMID: 18007270] CrossrefMedlineGoogle Scholar18. Dara SI, Afessa B. Intensivist-to-bed ratio: association with outcomes in the medical ICU. Chest. 2005;128:567-72. [PMID: 16100139] CrossrefMedlineGoogle Scholar19. Kahn JM, Brake H, Steinberg KP. Intensivist physician staffing and the process of care in academic medical centres. Qual Saf Health Care. 2007;16:329-33. [PMID: 17913772] CrossrefMedlineGoogle Scholar20. Kollef MH, Ward S. The influence of access to a private attending physician on the withdrawal of life-sustaining therapies in the intensive care unit. Crit Care Med. 1999;27:2125-32. [PMID: 10548193] CrossrefMedlineGoogle Scholar21. Zimmerman JE, Alzola C, Von Rueden KT. The use of benchmarking to identify top performing critical care units: a preliminary assessment of their policies and practices. J Crit Care. 2003;18:76-86. [PMID: 12800117] CrossrefMedlineGoogle Scholar22. Pronovost PJ, Holzmueller CG, Clattenburg L, Berenholtz S, Martinez EA, Paz JR, et al. Team care: beyond open and closed intensive care units. Curr Opin Crit Care. 2006;12:604-8. [PMID: 17077695] CrossrefMedlineGoogle Scholar23. Kahn JM, Matthews FA, Angus DC, Barnato AE, Rubenfeld GD. Barriers to implementing the Leapfrog Group recommendations for intensivist physician staffing: a survey of intensive care unit directors. J Crit Care. 2007;22:97-103. [PMID: 17548019] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Gordon D. Rubenfeld, MD, MSc; Derek C. Angus, MD, MPHAffiliations: From the University of Toronto, Toronto, Ontario MHN 3M5, Canada, and University of Pittsburgh School of Medicine, Pittsburgh, PA 15261.Potential Financial Conflicts of Interest: Drs. Rubenfeld and Angus are practicing intensivists.Corresponding Author: Gordon D. Rubenfeld, MD, MSc, Program in Trauma, Emergency, and Critical Care, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D503, Toronto, Ontario M4N 3M5, Canada; e-mail, gordon.[email protected]ca.Current Author Addresses: Dr. Rubenfeld: Program in Trauma, Emergency, and Critical Care, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D503, Toronto, Ontario M4N 3M5, Canada.Dr. Angus: University of Pittsburgh School of Medicine, 614 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAssociation between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit Mitchell M. Levy , John Rapoport , Stanley Lemeshow , Donald B. Chalfin , Gary Phillips , and Marion Danis What Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit? William T. 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McGee, MD, MHAWhat Conclusions Should Be Drawn between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit?Constantine Manthous, MD and Yaw Amoateng-Adjepong, MD, PhDOrganization and Structure of the Cardiothoracic Intensive Care Unit 3 June 2008Volume 148, Issue 11Page: 877-879KeywordsAbdominal surgeryCritical careHealth careIntensive care unitsLungsMortalityPatientsSurgeonsSystematic reviewsTrauma surgery ePublished: 3 June 2008 Issue Published: 3 June 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...