The intensive care unit--who's in charge? The private practice view

Area of Science:

• Surgery
• Critical Care Medicine

Background:

• Concerns exist regarding surgeons' decreasing involvement in preoperative and postoperative care within surgical intensive care units (SICUs).
• The traditional role of surgeons in direct patient management in SICUs is being questioned.

Purpose of the Study:

• To investigate the current role of surgeons in the management of critically ill surgical patients in private practice.
• To identify the extent to which surgeons are abdicating their responsibilities in SICU care.

Main Methods:

• A survey was conducted among surgical chiefs and SICU nurse managers.
• Questionnaires were distributed to 188 non-university-affiliated hospitals across the United States.

Main Results:

• Surgeons do not hold the principal managing role in SICUs for surgical patients in 70%–75% of surveyed hospitals.
• Surgeons are increasingly relinquishing direct care responsibilities for critically ill preoperative and postoperative patients.

Conclusions:

• The trend of surgeons relinquishing critical care responsibilities is significant.
• Key factors contributing to this trend include the increasing complexity of critical care, lack of economic incentives, and professional liability concerns.
• Addressing these three areas is crucial to reversing the observed trend and re-engaging surgeons in SICU care.