• Critical Care Illness

     
     
     
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    The critical care setting is a complex organizational environment.  Care is provided by a multidisciplinary interdependent team of critical care physicians (intensivists), critical care nurses, mid-level practitioners, respiratory therapists, pharmacists, social workers, physical therapists, nutritionists, and palliative care specialists.  These various healthcare professionals possess expert knowledge in physiology, pharmacology, the technical aspects of monitors and invasive equipment and management of the psychosocial issues surrounding the provisions of critical care to the critically ill.  Effective collaboration is essential to the overall function of the critical care unit, and significantly effects patient’s mortality and length of stay.  Critical care walk-rounds are the essential communication tool where the multidisciplinary team comes together to discuss the daily goals of care for each patient: recognizing daily problems, sharing information, initiating therapy, evaluating the effects of therapy, and providing learning opportunities for the critical care staff.  Many patients have multi organ failure; require constant monitoring and observation (e.g.; respiratory system failure, cardiovascular system failure; kidney failure).  Nurses maintain a constant presence at the bedside and play a critical role in monitoring these patients, providing minute-to-minute, hour-to-hour care.  The admission of a critically ill patient is a stressful time for family and friends.  There is a support system of social workers and palliative care specialists. 

    Facts:

    There are approximately 6,000 ICUs in the United States, caring for 55,000 critically ill patients daily; there are more than 4.4 million ICU admissions annually in the US.

    ICU beds account for approximately 10% of all hospital inpatient beds, yet result in 20-35% of all hospital operating costs.

    The total number of "adult ICU beds" (cardiac, medical/surgical, other ICUs and burn care) number approximately 70,000, and the total number of pediatric ICU beds (neonatal and pediatric) number about 21,000

    Critical care medicine beds increased by 6.5% (from 88,252 to 93,955) and ICU days by 10.6% (from 21 to 23.2 million) and occupancy rates by 4.5% (from 65 to 68%) between 2000-2005

    In 2005, 90% of critical care medicine beds were classified as intensive care, premature/ neonatal and coronary care units. 

    In 2005, critical care medicine cost represented 13.4% of all hospital costs, 4.1% of national health expenditure and 0.66% -1% of the US gross domestic product. (60-90 billion dollars). 

    The most frequent source of ICU admissions is the emergency department (40%), followed by the peri-operative arena (35%); the remainder (21%) come from other inpatient floors

    Care in the ICU primarily involves treatment and procedures (55%); monitoring for cardiovascular, respiratory or neurologic instability (34%); preoperative observation (6%); and safety monitoring (5%)

    Procedures performed in the ICU include tracheal intubation (23%); mechanical ventilation (22%); arterial lines (21%); and central venous access (16%); thoracostomy (7%); and pulmonary artery catheterization (7%) in 2006

    An ICU bed costs on average 3,500- 4,000 dollars a day

    In the United States, approximately 5000,000 patients die in an ICU each year representing an overall ICU mortality rate of 12-17%; which accounts for 59% of all in-hospital deaths

    Patients 65 years of age and older account for 40% of all hospital discharges and 55.8% of all ICU days

     

    Critical Care Websites for Consumers

    http://www.nlm.nih.gov/medlineplus/criticalcare.html 

    From Medline Plus- lots of good links and PDFs

    http://jama.ama-assn.org/search?fulltext=patient+pages+AND+critical+care&submit=yes

    JAMA Patient Pages that are about critical care.

    http://www.aacn.org/WD/Certifications/Content/consumer-whattoexpect.pcms?menu=Certification&lastmenu=

    From the AACN “What to expect when a loved one is critically ill”.

    http://icu-usa.com/tour/index.htm

    From ICU-USA

    http://icusteps.org/guide

    From ICU Steps, which is a British organization, but this PDF document has excellent patient information, including what to expect after having been in ICU.

    http://www.sccm.org

    Society of Critical Care Medicine link

    Articles:

    Critical care medicine in the United States 2000-2005: An analysis of bed numbers, occupancy rates, payer mix, and cost.  NA Helpern, Stephen M. Pastures MD.  Crit Care, Med.  2010; 38: 65-71

    Critical Care in the United States of America. F. Elizabeth Poalillo, Edgar J. Jimenez, Jay Falk. Crit Care Clin 22 (2006) 447-455

    Author: Doug Norcross, MD (2011)