On the horizon: ICU turf battle

Dear Medical Staff Leader:

A new battleground in privileging "turf wars" is the intensive care unit (ICU). As the acuity of care delivered in hospitals increases, more of it requires sophisticated patient monitoring and frequent intervention. More then four million patients are admitted to ICUs each year in the United States, and approximately 500,000 patients die in ICUs every year.

A growing body of literature suggests that the quality of care delivered in ICUs varies considerably from hospital to hospital. Traditionally, the patient's attending physician managed ICU care. That is still typically the case today when the attending is an internist or family physician. These "generalists" call on a variety of specialists to consult and assist in managing their critically ill patients. However, intensivists are staffing a growing number of ICUs. These physicians devote much of their time to managing ICU patients and have usually received training in critical care medicine. As they become more prevalent in hospitals, intensivists have shown that they can lower error rates in the ICU and reduce mortality. As a result, some medical staffs have started to limit the ICU privileges of internists, surgeons, and family physicians-some of whom are reluctant to relinquish those privileges.

The dispute over ICU privileges differs from many other specialty turf battles because parties outside of the medical community influence it heavily. In particular, the business community has argued that using intensivist in the ICU will provide higher quality, safer, and more cost-effective care. The growing strength of large business coalitions in the community may, in the future, give hospitals little choice but to close ICUs to everyone but intensivists. The medical community may not be able to turn its back on such demands for change.

As the pressure continues to mount on hospitals to adopt an intensivist model of ICU coverage, ICU privileging will become a more contentious issue between those with critical care training and those without. Hospital leaders will have to carefully consider the direction in which they want to take their ICUs and the damage that hasty privileging decisions may have on the hospital's relationship with its medical staff.

That's all for this week!

All the best,

Rick Sheff, MD
http://www.greeley.com/seminars/