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Does Practice Match Training? Consultation Practices in Surgical Critical Care.

Christopher P Michetti1, Susan L Evans2, Niels D Martin3

  • 1Annandale, Virginia.

The Journal of Surgical Research
|March 22, 2023
PubMed
Summary

Surgical critical care (SCC) physicians consult specialists for common conditions but rarely for topics within their training, indicating practice aligns with SCC curriculum. Consultation patterns vary by specialty and diagnosis.

Keywords:
ConsultConsultationIntensive care unitSurgical critical careSurvey

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Area of Science:

  • Critical Care Medicine
  • Surgical Critical Care
  • Medical Education

Background:

  • Intensive care unit (ICU) patient and provider factors influence specialty consultation needs.
  • Understanding the practice patterns of surgical critical care (SCC) physicians for ICU consultations is essential for optimizing patient care and resource allocation.

Purpose of the Study:

  • To determine the practice patterns of surgical critical care (SCC) physicians regarding ICU consultations.
  • To assess which conditions prompt SCC physicians to consult specialists and compare this to the SCC fellowship curriculum.

Main Methods:

  • A survey was distributed to members of the American Association for the Surgery of Trauma.
  • Respondents indicated conditions for which they would consult specialists, which were cross-referenced with the SCC fellowship curriculum.
  • Physician confidence in managing specific conditions and perspectives on consultation practices were also queried.

Main Results:

  • 314 SCC physicians responded, with most practicing SCC for 26-50% of their clinical time.
  • Highest confidence was in managing ventilators, palliative care, and infections; lowest was in myocardial ischemia.
  • Consultations were most frequent for Cardiology, Hematology, and Neurology, and less frequent for topics within the SCC curriculum, except infectious diseases and palliative care.

Conclusions:

  • ICU consultation practices among SCC physicians are influenced by consultant specialty and patient diagnosis.
  • Consultations are common for specialty-specific issues but infrequent for topics covered in the SCC curriculum, suggesting practice aligns with training.
  • Continuous 24-hour attending physician coverage in ICUs was associated with fewer consultation topics.