The intensive care unit--who's in charge? The private practice view
A. L. Trask and D. R. Faber
Department of Surgery, University of Miami, School of Medicine, Fla.
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.
