Delivery of critical care in North American burn centers.
Delivery of critical care in North American burn centers.
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在北美烧伤中心提供重症监护。
DOI：
10.1097/bcr.0b013e31818480b8
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Gibran,NicoleS
中科院分区：
文献类型：
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作者：
Reimel,BethAnn;Klein,MatthewB;Nathens,AveryB;Gibran,NicoleS
重症患者的管理是烧伤管理的重要组成部分。随着重症监护实践变得更加专业化，以及像Leapfrog集团这样的付款人坚持重症监护提供的组织结构，我们试图确定北美烧伤中心如何提供重症监护。许多外科和内科重症监护病房（ICU）遵循重症监护模式，具有以下特征：1）ICU医生主任是重症监护委员会认证，2）超过50%的ICU医生是重症监护委员会认证，3）重症监护团队有权撰写患者订单。我们假设重症监护模式在北美烧伤中心并不常见。一百二十七烧伤外科医生进行了调查，使用基于网络的问卷，解决机构的体积，参加重症监护认证，重症监护团队的参与，并实施循证实践。共有64名外科医生完成了调查（51%）。根据几位重症监护医师的意见，模型标准因ICU容量和验证状态而异。ICU容量较低的中心更有可能拥有每天查房的重症监护团队（69% vs. 29%，P = .02）。未经认证的中心更有可能有ICU外的无责任的ICU参与（22%对0%，P = 0.01）。经验证的中心更可能有专门的ICU发病率和死亡率会议（63%vs.35%，P = .02）。这项调查的结果表明，许多北美烧伤中心不使用重症监护模式的关键护理交付。
The management of severely ill patients is an essential component of burn management. As critical care practices become more specialized, and payers such as the Leapfrog group insist on organizational structure for critical care delivery, we sought to determine how critical care is delivered in North American burn centers. Many surgical and medical intensive care units (ICUs) follow an intensivist model with the following features: 1) ICU physician-director is board-certified in critical care, 2) more than 50% of the ICU physicians are board-certified in critical care, and 3) an intensive care team has authority to write patient orders. We hypothesized that the intensivist model is uncommon in North American burn centers. One hundred twenty-seven burn surgeons were surveyed using a web-based questionnaire that addressed institutional volume, attending critical care certification, involvement of intensivist teams, and implementation of evidenced-based practices. A total of 64 surgeons completed the survey (51%). In accordance with several intensivist, model criteria varied by ICU volume and verification status. Lower ICU volume centers are more likely to have an intensivist team that rounds daily (69% vs. 29%,P= .02). Nonverified centers are more likely to have ICU attending without responsibilities outside of the ICU (22% vs. 0%,P= .01). Verified centers are more likely to have dedicated ICU morbidity and mortality conferences (63% vs. 35%,P= .02). Results of this survey indicate that many North American Burn Centers do not use the intensivist model of critical care delivery.