Huang David T, Osborn Tiffany M, Gunnerson Kyle J, Gunn Scott R, Trzeciak Stephen, Kimball Edward, Fink Mitchell P, Angus Derek C, Dellinger R Phillip, Rivers Emanuel P
The CRISMA Laboratory (Clinical Research, Investigation, and Systems Modeling of Acute Illness), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Crit Care Med. 2005 Sep;33(9):2104-9. doi: 10.1097/01.ccm.0000173412.43562.b3.
Demand for critical care services is increasing. Unless the supply of intensivists increases, critically ill patients will not have access to intensivists. Recent critical care society recommendations include increased graduate medical education support and expansion of the J-1 visa waiver program for foreign medical graduates. This article proposes additional recommendations, based on strengthening the relationship between emergency medicine and critical care medicine. Demand for critical care services is increasing. Unless the supply of intensivists increases, critically ill patients will not have access to intensivists. Recent critical care society recommendations include increased graduate medical education support and expansion of the J-1 visa waiver program for foreign medical graduates. This article proposes additional recommendations, based on strengthening the relationship between emergency medicine (EM) and critical care medicine (CCM). Critical care is a continuum that includes prehospital, emergency department (ED), and intensive care unit (ICU) care teams. Both EM and CCM require expertise in treating life-threatening acute illness, with many critically ill patients often presenting first to the ED. Increased patient volumes and acuity have resulted in longer ED lengths of stay and more critical care delivery in the ED. However, the majority of CCM fellowships do not accept EM residents, and those who successfully complete a fellowship do not have access to a U.S. certification exam in CCM. Despite these barriers, interest in CCM training among EM physicians is increasing. Dual EM/CCM-trained physicians not only will help alleviate the intensivist shortage but also will strengthen critical care delivery in the ED and facilitate coordination at the ED-ICU interface. We therefore propose that all accreditation bodies work cooperatively to create a route to CCM certification for emergency physicians who complete a critical care fellowship.
对重症监护服务的需求正在增加。除非重症医学专家的数量增加，否则重症患者将无法获得重症医学专家的治疗。重症监护协会最近的建议包括增加研究生医学教育支持，以及扩大针对外国医学毕业生的J-1签证豁免计划。本文基于加强急诊医学和重症医学之间的关系提出了其他建议。对重症监护服务的需求正在增加。除非重症医学专家的数量增加，否则重症患者将无法获得重症医学专家的治疗。重症监护协会最近的建议包括增加研究生医学教育支持，以及扩大针对外国医学毕业生的J-1签证豁免计划。本文基于加强急诊医学（EM）和重症医学（CCM）之间的关系提出了其他建议。重症监护是一个连续过程，包括院前、急诊科（ED）和重症监护病房（ICU）护理团队。急诊医学和重症医学都需要治疗危及生命的急性疾病的专业知识，许多重症患者通常首先就诊于急诊科。患者数量和病情严重程度的增加导致急诊科住院时间延长，以及急诊科提供更多的重症监护服务。然而，大多数重症医学专科培训项目不接受急诊医学住院医师，而那些成功完成专科培训的人无法参加美国重症医学认证考试。尽管存在这些障碍，急诊医学医生对重症医学培训的兴趣正在增加。接受急诊医学/重症医学双重培训的医生不仅将有助于缓解重症医学专家短缺的问题，还将加强急诊科的重症监护服务，并促进急诊科与重症监护病房之间的协调。因此，我们建议所有认证机构合作，为完成重症医学专科培训的急诊医生创造一条获得重症医学认证的途径。
