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

摘要

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.