Science & Technology: U.S. Critical Care Delivery System in Critical Condition

Stakeholder group led by Pitt Researchers calls for reorganization of critical care in the UnitedStates

The demand for critical-care services in the United States will soon outpace the supply of specialists trained in intensive care—a situation that, if not remedied, may prove fatal for critically ill patients. The solution to this problem lies not in recruiting and training more personnel but in reorganizing the critical-care system nationwide, according to a report from a group of critical-care stakeholders led by Pitt School of Medicine researchers.

The group’s report was published in the April issue of the journal Critical Care Medicine.

“The number of Americans over the age of 65 is expected to double by 2030. In addition to nonelective medical admissions for critical illness among chronically ill elders, the growth rate in elective surgical procedures requiring intensive care unit admission, such as bypass surgery, is growing fastest among this age group,” said Amber E. Barnato, an assistant professor in the Pitt medical school’s Department of Medicine.

“All of this means more and more people will demand already strained intensive-care services,” Barnato said. “This anticipated mismatch between supply and demand is perhaps no different for critical-care services than for other medical care disproportionately serving elders—ranging from emergency services to long-term care services—but the opportunities for improving the efficiency of the existing system to meet demand are probably greater.”

The report, developed following a September 2005 meeting of critical-care stakeholders called Prioritizing the Organization and Management of Intensive Care Services (PrOMIS) Conference, calls for the creation of a tiered, regionalized system for critical-care services in an effort to centralize expertise, equipment, and facilities. This would make the necessary critical-care services readily available to patients most in need.

“Prior conferences aimed at addressing this problem sought input only from criticalcare professionals, who are a fraction of all the stakeholders,” said Barnato, lead author of the PrOMIS report. “These groups often stated the need for more trained providers. Surveying a wider group of interested parties, we found that this isn’t necessarily the best or only solution.”