Evolving a Successful Acute Care Surgical/Surgical Critical Care Group at a Nontrauma Hospital

A large acute care but nontrauma teaching hospital in Manhattan, New York performing 24 000 operations/year has evolved a Surgical Intensive Care Unit (SICU) Service with 3 attendings and 5 physician assistants over 9 years. The division follows nationally recognized, published best practices in shock, sepsis, ventilator management, nutrition, and antibiotic use and has maintained a total mortality of 1.9% (varying between 1.5% and 2.1%) for 9 years. Although PGY-1 and PGY-2 residents rotate through SICU, the division relies heavily on experienced, Fundamentals of Critical Care Support–trained physician assistants for organized consultation and ensuring adherence to best practices in daily patient care. For the past 4 years, the division has provided 24/7 in-house attending coverage in collaboration with the Division of Cardiac Surgery. In-house attending intensivist/cardiac surgeon coverage did not improve mortality. The division also provides approximately one third of the institution’s acute care surgery in rotation/collaboration with general surgeons. The practicalities of the division’s evolution and recommendations are discussed.