【精品文档】Critical Care Delivery in ICU.pptVIP

Critical Care Delivery in ICU Defining the clinical roles and the best practice model From: Crit Care Med 2001:29:2007 -2019 Economic Impact of ICU (1994) * 10% of hospital beds * 30% of acute care hospital cost * 20% of hospital budget * 1% of GNP expended for ICU care With aging of the population ? Demand for critical care service will increase ICU So expensive per patient per time interval We need data about the type and quality provided in ICU Two Questions 1. Role and practice of an intensivist 2. The best practice model in ICU USA vs Taiwan 現在的美國就是10年後的台灣 10-15年前的美國就是現在的台灣 1991 Survey in USA 8% of hospital beds in USA are ICU beds 10-12 beds per unit for adult ICU 21 beds per unit for neonatal ICU Occupancy rate : 84% Category of ICU MICU: 36% mixed: 22% ICU directors : internist : 63% of all ICU 1991 Survey in USA ICU directors : 61% : part time 50% : unpaid 56% : not certified in critical care medicine In 1991, full time intensivists were still not common in USA ICU director authorized admission to ICU Pediatric: 31% Neonatal: 30% Surgical: 20% Medical: 2% 100 beds: 9% 500 beds: 56% ICU Survey (1997) ICU administrator Anesthesia : 0.6% Medicine : 36.7% Surgery : 16% Free : 29.1% Others : 17.6% ICU Model Care Full-time intensivist model : patient care is provided by an intensivist Consultant intensivist model : an intensivist consults for another physician to coordinate or assist in critical care, but dose not have primary responsibility for care Multiple consultant model: multiple specialists are involved in the patient care, (esp. R/T doctors for ventilators), but none is designated especially as the consultant intensivist Single physician model : primary physician provides all ICU care ICU Survey (1997) For all ICU patients in 1997, cared by Full time intensivist : 23.1% Consultant intensivist : 13.7% Multiple consultant : 45.6% S