THE ANESTHESIOLOGIST PHYSICIAN MEDICAL SPECIALIST

The following slide presentation is part of the ASA Public Education Slide series. Copyright © 2003 American Society of Anesthesiologists. All rights reserved. THE ROLE OF THE ANESTHESIOLOGIST IN THE INTENSIVE CARE UNIT (ICU) American Society of Anesthesiologists Public Education Series Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Copyright © 2003 American Society of Anesthesiologists. All rights reserved. 1998 Demographics of ICU Care • • • 5,981 adult, non-cardiac ICUs 72,416 ICU beds 54,829 ICU patients per day 20,000,000 patient days per year Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS) Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Intensive Care Unit • • • Aging population Trauma Disaster preparedness Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Cost of Critical Care • • • • 5-10% of total beds in the US 15-20% of all hospital costs Hospital cost ~ 38% of total U.S. health care costs Annual cost of critical care ~ $64 billion (1995) ATS BOD. Am J Resp Crit Care Med. 1997;156:1282-1301 Chalfin. Intensive Care Med. 1995;21:952-961 Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Cost of Critical Care • • Health care is expensive: ~ 13.5% GDP on Health Care (~ 7.5% ICU) Critical Care Medicine is expensive: ~ 1% of Gross National Product • Costs have increased ~ 6-12% per year The Expensive Care Unit Ingelhart NEJM 1999;340:70-76 Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Physicians who specialize in Critical Care Medicine play a pivotal role in improving patient outcomes and decreasing the cost of intensive care. Copyright © 2003 American Society of Anesthesiologists. All rights reserved. ICU Mortality 0.5 Mortality rate for high intensity physician staffing line of equivalency 0.4 Favors low intensity physician staffing Brown 0.3 Manthous Ghorra Marini Favors high intensity physician staffing 0.2 Pollack Reich Al-Asadi 0.1 0 0 0.1 0.2 0.3 0.4 0.5 Mortality rate for low intensity physician staffing Copyright © 2003 American Society of Anesthesiologists. All rights reserved. ICU Length of Stay 14 line of equivalency 12 ICU LOS for high intensity staffing 10 Favors low intensity physician staffing Carson Hanson Li Manthous Marini Multz1 8 6 Multz2 Pronovost Reynolds Tai 4 2 Favors high intensity physician staffing 0 0 2 4 6 8 10 12 14 ICU LOS for low intensity staffing Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Leapfrog Group Recognized the importance of having trained intensivists in ICUs to provide care for critically ill patients. Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Management of the critically ill patient is a challenge. Anesthesiologists possess the skills necessary to meet this challenge. Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Copyright © 2003 American Society of Anesthesiologists. All rights reserved. • • • • Anesthesiologists have historically been leaders in providing critical care services. The first “Respiratory Care Units” were established by anesthesiologists in the 1950s. Anesthesiologists have played a pivotal role in the development of monitoring, life support and resuscitation. Anesthesiologists are leaders in the science of safe systems in health care. Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Anesthesiologists have made significant contributions to the understanding of critical illnesses and in the development of effective treatment methods. Copyright © 2003 American Society of Anesthesiologists. All rights reserved. RISK OF ANESTHESIA Anesthetic Mortality 20 18 16 14 12 10 8 6 4 2 0 Deaths per 10,000 anesthetics 17.9 2.2 0.7 1980 0.04 1989 1950 1975 Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Severinghaus Pontoppidan Anesthesiologist Contributions to ICU Care Bendixen Downs Kirby Safar Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Recent Advances in Critical Care Medicine • • • • • Respiratory management in acute lung injury Treatment of sepsis Management of sedation and analgesia Management of blood sugar Transfusion therapy Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Recent Advances in Critical Care Medicine • • • • Development of strategies to reduce the incidence of ventilator-associated pneumonia Therapies to prevent deep venous thrombosis Therapies to prevent gastrointestinal bleeding Treatment of cardiac dysfunction and rhythm abnormalities Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Anesthesiologists have particular expertise in: • Physiology of all organ systems – Normal physiology – Physiology related to disease, illness, surgery, trauma – Resuscitation • Pharmacology – – – – Sedatives Analgesics Muscle relaxants Resuscitation medications Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Anesthesiologists have particular expertise in: • • • • • Airway management and respirators Management of pain Invasive monitoring Management of the surgical patient Patient safety Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Copyright © 2003 American Society of Anesthesiologists. All rights reserved. The American Board of Anesthesiology was the first specialty board to offer a special qualification examination process in Critical Care Medicine. Copyright © 2003 American Society of Anesthesiologists. All rights reserved. THE ANESTHESIOLOGIST PHYSICIAN / MEDICAL SPECIALIST • • • • • • 4 years college 4 years medical school 1 year internship 3 years residency training in anesthesiology 6 months critical care medicine 1 year subspecialty fellowship training in Critical Care Medicine Copyright © 2003 American Society of Anesthesiologists. All rights reserved. THE ANESTHESIOLOGIST PHYSICIAN / MEDICAL SPECIALIST American Board of Anesthesiology written examination  oral examination  recertification examination  subspecialty certification  Copyright © 2003 American Society of Anesthesiologists. All rights reserved. THE ANESTHESIOLOGIST NOT JUST IN THE OPERATING ROOM • Operating room hospital surgical center physician office • • • “Code Blue” team Respiratory therapy Administration operating room hospital medical school • • • • • Labor & delivery suite Other procedural areas Intensive care unit PACU Pain management acute chronic / cancer • Education health professionals public • Research Copyright © 2003 American Society of Anesthesiologists. All rights reserved. Copyright © 2003 American Society of Anesthesiologists. All rights reserved.