Emerging Trends in Icu Management and Staffing

Intensive care units (ICUs) comprise up to 10% of all hospital beds in the United States and consume as much as 34% of hospital resources. This is over 1% of the gross domestic product (GDP) 7 or nearly $64 billion per year. 15 There are between 50,000 and 100,000 patients in an ICU on any given day in the United States and the demand for critical care beds will continue to grow as the population ages. 21 Managed care and reduced reimbursement for services have forced hospitals to focus on these high-cost areas and reassess the best approach to improving patient care outcomes in the most cost-effective way. 8,9,11 This article addresses various staffing and organizational models that are either being introduced or considered for intermediate or long-term implementation. Recent experience at the authors' institution has resulted in a critical care model that offers 24 hours per day, 7 days a week on-site coverage by qualified intensivists and maintains significant input from primary care physicians and other specialists caring for the patient. This model is outlined here. There are few evidence-based outcome studies available to guide health care delivery. 26 The authors describe the advantages to an organized multidisciplinary team approach to critical care delivery and review the existing data to support this approach.