Surgical Intensive Care Unit (SICU) Models of Care: Current Practices & Perspectives
Aisha Shaheen MD, MHA; Benjamin Kohl MD, FCCM; Abhay Mathur, B.S; Michael S. Weinstein MD, FCCM, FACS

Introduction: Surgical critical care services are delivered through a variety of practice models. Increased intensives involvement in the ICU has been shown to improve care and clinical outcomes for patients. However, data regarding actual practices in ICU models of care has as of yet not been quantified. This study seeks to characterize current practices and perceptions of intensives involvement in ICUs with surgical critical care training programs. Methods: A 25-question survey on an internet-based platform was sent to program directors of all ACGME-approved surgical critical care programs that were registered with Surgical Critical Care Program Directors Society (SCCPDS). Participants were queried on the setting of their ICU, their current staffing and management models (e.g. open versus closed ICU) and asked to describe their optimal model of care for an ICU. Results: Fifty-two of one hundred (52%) contacted completed the questionnaire. Respondents were largely affiliated with academic medical centers (82.7%) and represented twenty-seven states in the continental U.S. Respondents currently based in both open (71.4%) and closed (81.3%) units largely favored a high-intensity staffing model with mandatory intensives consultation. Those surveyed reported conflicts between the primary surgeon and intensives were usually resolved by consensus (71.4%) and not deferral to either the ICU or primary surgical team. Conclusions: Current practices of ICU models of care are presented and intensives education, responsibilities, and authority in clinical decision-making are characterized. Intensives in our study overwhelming favored closed units and high-intensity involvement.

Full Text: PDF     DOI: 10.15640/ijhs.v4n2a3