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The Intensive Care Unit—Who's in Charge?: The Private Practice View

The Intensive Care Unit—Who's in Charge?: The Private Practice View Abstract • In the past 10 years, a number of authors have expressed concern that surgeons are abdicating their traditional role of providing preoperative and postoperative care in surgical intensive care units. To study today's private practice environment, we took a survey. Questionnaires were sent to the chiefs of surgery and the nurse managers of the surgical intensive care units at 188 non—university-affiliated hospitals throughout the United States. Results show that surgeons do not have the principal managing role in the intensive care unit for surgical patients in 70% to 75% of the hospitals. Results also indicated that surgeons are relinquishing their responsibilities in the direct care of the preoperative and postoperative critically ill patients. Three main reasons are given for this: (1) an ever-increasing body of critical care knowledge plus complex technology, (2) a lack of economic incentive, and (3) professional liability. To reverse this trend, these three areas must be addressed. (Arch Surg. 1990;125:1105-1108) References 1. Maloney JV. Itinerant surgery: at home and on the road . Ann Surg . 1984;200:115-116.Crossref 2. Kron IL, Kaiser DL, Nolan SP, Crosby IK, Mentzer RM, Rheuban K. Who manages the postoperative cardiac patient? J Thorac Cardiovasc Surg . 1984;87:629-630. 3. Spencer RC, Skinner DB. The role of the surgeon in the intensive care unit . J Thorac Cardiovasc Surg . 1984;88:483-485. 4. Magovern GJ. The role of the thoracic surgeon in the intensive care unit . Ann Thorac Surg . 1984;38:309.Crossref 5. Greenbaum DM. Availability of critical care personnel, facilities, and services in the United States . Crit Care Med . 1984;12:1073-1077.Crossref 6. Machiedo GW, Blackwood JM, Rush BF. Practice of critical care medicine in academic surgical care centers . J Surg Res . 1981;30:223-228.Crossref 7. Preoperative and Postoperative Care Committee of the American College of Surgeons. The surgeon and intensive care . Am Coll Surg Bull . 1985;70:25-26. 8. Walt AJ. The training and role of the surgeon in the intensive care unit . Surg Clin North Am . 1985;65:753-762. 9. Hsiao WC, Braun P, Yntema D, Becker ER. Estimating physician's work for a resource-based relative-value scale . N Engl J Med . 1988;319:835-841.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

The Intensive Care Unit—Who's in Charge?: The Private Practice View

Archives of Surgery , Volume 125 (9) – Sep 1, 1990

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Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1990.01410210031003
Publisher site
See Article on Publisher Site

Abstract

Abstract • In the past 10 years, a number of authors have expressed concern that surgeons are abdicating their traditional role of providing preoperative and postoperative care in surgical intensive care units. To study today's private practice environment, we took a survey. Questionnaires were sent to the chiefs of surgery and the nurse managers of the surgical intensive care units at 188 non—university-affiliated hospitals throughout the United States. Results show that surgeons do not have the principal managing role in the intensive care unit for surgical patients in 70% to 75% of the hospitals. Results also indicated that surgeons are relinquishing their responsibilities in the direct care of the preoperative and postoperative critically ill patients. Three main reasons are given for this: (1) an ever-increasing body of critical care knowledge plus complex technology, (2) a lack of economic incentive, and (3) professional liability. To reverse this trend, these three areas must be addressed. (Arch Surg. 1990;125:1105-1108) References 1. Maloney JV. Itinerant surgery: at home and on the road . Ann Surg . 1984;200:115-116.Crossref 2. Kron IL, Kaiser DL, Nolan SP, Crosby IK, Mentzer RM, Rheuban K. Who manages the postoperative cardiac patient? J Thorac Cardiovasc Surg . 1984;87:629-630. 3. Spencer RC, Skinner DB. The role of the surgeon in the intensive care unit . J Thorac Cardiovasc Surg . 1984;88:483-485. 4. Magovern GJ. The role of the thoracic surgeon in the intensive care unit . Ann Thorac Surg . 1984;38:309.Crossref 5. Greenbaum DM. Availability of critical care personnel, facilities, and services in the United States . Crit Care Med . 1984;12:1073-1077.Crossref 6. Machiedo GW, Blackwood JM, Rush BF. Practice of critical care medicine in academic surgical care centers . J Surg Res . 1981;30:223-228.Crossref 7. Preoperative and Postoperative Care Committee of the American College of Surgeons. The surgeon and intensive care . Am Coll Surg Bull . 1985;70:25-26. 8. Walt AJ. The training and role of the surgeon in the intensive care unit . Surg Clin North Am . 1985;65:753-762. 9. Hsiao WC, Braun P, Yntema D, Becker ER. Estimating physician's work for a resource-based relative-value scale . N Engl J Med . 1988;319:835-841.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Sep 1, 1990

References

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