Hospitalists serving as attending physicians were overwhelmingly found in ICUs in hospitals where intensivists were used mostly as elective consultations, according to a study to be published in this month’s Journal of Hospital Medicine.
The report, "Characteristics of Intensive Care Units in Michigan: Not an Open and Closed Case" (JHM. 2010;5:4-9), is a cross-sectional survey of 115 ICUs in 72 Michigan hospitals. The way critical care is delivered is an issue many hospitalists pay mind to as they often are called upon to compensate for workforce shortages even though few are board-certified in critical care. The study reported that 25% of sites used a closed model of intensive care, and that those units were larger than sites with open ICUs (P<0.05). Hospitalists serving as attendings were "strongly associated with an open ICU" (odds ratio 95%; confidence interval=12.2).
"Because our study shows that hospitalists are already providing intensive care in many areas of Michigan … the best strategy [for hospitalists] would be to work within that context,” says lead researcher Robert C. Hyzy, MD, FCCM, associate professor in the Department of Internal Medicine and director of the Critical Care Medicine Unit at the University of Michigan in Ann Arbor.
Dr. Hyzy says hospitalists will "continue to play an important role" in ICU care as long as the intensivist shortage continues, even though many don’t have the extensive training to do so. Telemedicine has been used in recent years to help address the ICU physician shortage, although the debate continues as to its effectiveness on morbidity and mortality rates. In the meantime, Dr. Hyzy reports, only 20% of the sites in his study reported all attending physicians were board-certified in critical care; 60 sites had less than 50% board-certified attending physicians.
“Hospitalists can play a role in acknowledging the limitations of individuals who are not properly trained in critical care to advocate for transfer to larger centers under explicit clinical circumstances,” Dr. Hyzy says.
As a member of the Society of Critical Care Medicine’s (SCCM) fellowship program, Dr. Hyzy also urges any hospitalists who deliver critical-care services to investigate the SCCM’s certification track and to take advantage of any training opportunities available to them.