Delivery of critical care in North American burn centers

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.