Shedding an unlovely light on critical care workload.

摘要

Critical care is hard work, getting harder. The numbers of critical care beds and critically ill patients have been increasing. This has been largely attributable to the aging of the U.S. population (1), but perhaps also to widespread use of invasive technologies, immunosuppression, and complex surgery that predispose to critical illness. The expansion of the critical care-trained physician workforce has not kept pace. Between 2006 and 2010, the annual number of trainees entering surgical and pulmonary and critical care training programs increased by 97 (2), and the annual number of board certifications (new and renewal) in internal medicine critical care increased by 74 (3). This translates into a growing manpower shortfall (1, 4), greater likelihood of a critically ill patient being treated by those lacking relevant specialty training, and consequently, a greater chance of their dying (5). From an inten-sivist's perspective, it means more patients to see each day. Adding to this patient load are other external forces, including increased regulatory and documentation burdens from hospital accreditation agencies, insurers, and educational accrediting councils, rising expectations for flawless infection-control practices, sterling records of patient safety, and 24-hr physician hospital presence. Worthy goals all, but it would be negligent to fail to acknowledge their cumulative toll along with their individually demonstrated benefits.