Expanding intensive care medicine beyond the intensive care unit.docVIP

Available online /content/8/1/9 Commentary Expanding intensive care medicine beyond the intensive care unit Ken Hillman Professor of Intensive Care, University of New South Wales, Liverpool Hospital, Sydney, Australia Correspondence: Ken Hillman Published online: 13 October 2003 Critical Care 2004, 8:9-10 (DOI 10.1186/cc2394) This article is online at /content/8/1/9 ? 2004 BioMed Central Ltd (Print ISSN 1364-8535; Online ISSN 1466-609X) Abstract Intensive care medicine probably requires the artificial boundaries of an intensive care unit to nurture and legitimize the specialty. The next major step in intensive care medicine is to explore ways of optimizing the outcome of seriously ill patients by recognizing and resuscitating them at an earlier stage. Some of these ways include better education of existing staff; earlier consultation; and automatic calling by intensive care staff to abnormalities identifying at-risk patients. Some of these interventions are currently being evaluated and results should soon indicate their relative effectiveness. Keywords critical care, intensive care, medical emergency team, outreach teams, seriously ill Introduction with general ward nursing staff, offer 24 hour care, often under the direction of a single specialist who takes ultimate responsibility for the patient. An article presented in this issue of Critical Care [1] provides an excellent review of the problem of dealing with seriously ill hospital patients when they are not in an intensive care environment. Many studies have now demonstrated that current care for hospital patients in general wards is inadequate [2–4]. If we as intensivists are to be involved in the care of the seriously ill outside the four walls of the intensive care unit (ICU), then how best do we reach out? This system has worked well over the centuries. However, medicine has become more specialized and patients now have multiple problems,