Does Practice Match Training? Consultation Practices in Surgical Critical Care

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.