Affiliations: Drs. Gajic and Afessa are affiliated with the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine.
Correspondence to: Bekele Afessa, MD, FCCP, Division of Pulmonary and Critical Care, Mayo Clinic, 200 First St SW, Rochester MN 55905; e-mail: email@example.com
Financial/nonfinancial disclosures: The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).
© 2009 American College of Chest Physicians
We thank Dijkema and colleagues for their comments regarding our review1 in CHEST (April 2009) about physician staffing models and patient safety in the ICU. They bring up important issues concerning ICU utilization and staffing shortage. They highlight the imbalance between ICU-staffing demand and supply, regional variations in the utilization of ICU resources, and the factors that influence triaging decisions for ICU admission. We agree with their comments.
The triage decisions regarding who will or will not benefit from ICU care are difficult to make.2 Although most physicians agree in principle that patients who are too well or too sick to benefit from ICU support should be denied ICU admission, the judgment of clinicians in determining who is sick enough to benefit from ICU admission is far from perfect. Observational studies3,4 have suggested that early intervention in the ICU is of critical importance in patients whose condition is deteriorating on the regular hospital ward. A multinational European, prospective, observational study (“Triage Decision Making for the Elderly in European ICUs” [or ELDICUS]) has just been completed, and we hope it will improve our understanding of triage decisions.
Staffing models that include appropriately trained critical care specialists facilitate decision making in these challenging situations.1 The regionalization of critical care similar to what has been done in trauma care, telemedicine approaches, and widespread training of hospital providers in the fundamentals of critical care support are some of the potential solutions for staffing shortage.
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