Department of Pulmonary and Critical Care, University of Kentucky, Lexington, KY.
Department of Medicine, Scott & White/Texas A&M HSC College of Medicine, Temple, TX.
Chest. 2012 Apr;141(4):959-966. doi: 10.1378/chest.11-2073. Epub 2011 Dec 29.
The objectives of this study were to determine the current staffing models of practice and the frequency of 24/7 coverage in academic medical centers in the United States and to assess the perceptions of critical care trainees and program directors toward these models.
A cross-sectional national survey was conducted using an Internet-based survey platform. The survey was distributed to fellows and program directors of 374 critical care training programs in US academic medical centers.
We received 518 responses: 138 from program directors (PDs) (37% of 374 programs) and 380 fellow responses. Coverage by a board-certified or board-eligible intensivist physician 24/7 was reported by 33% of PD respondents and was more common among pediatric and surgical critical care programs. Mandatory in-house call for critical care trainees was reported by 48% of the PDs. Mandatory call was also more common among pediatric-critical care programs compared with the rest (P < .001). Advanced nurse practitioners with critical care training were reported available by 27% of the PDs. The majority of respondents believed that 24/7 coverage would be associated with better patient care in the ICU and improved education for the fellows, although 65% of them believed this model would have a negative impact on trainees' autonomy.
Intensivist coverage 24/7 was not commonly used in US academic centers responding to our survey. Significant differences in coverage models among critical care medicine specialties appear to exist. Program director and trainee respondents believed that 24/7 coverage was associated with better outcomes and education but also expressed concerns about the impact of this model on fellows' autonomy.
本研究旨在确定美国学术医疗中心的实践人员配备模式和 24/7 覆盖的频率，并评估重症监护培训生和项目主任对这些模式的看法。
采用基于互联网的调查平台进行了一项横断面全国性调查。该调查分发给美国学术医疗中心 374 个重症监护培训项目的研究员和项目主任。
我们收到了 518 份回复：138 份来自项目主任（PD）（374 个项目中的 37%）和 380 份研究员回复。33%的 PD 受访者报告说，有一名经过董事会认证或有资格认证的重症监护医师 24/7 提供服务，这种情况在儿科和外科重症监护项目中更为常见。48%的 PD 报告说，重症监护培训生必须随叫随到。与其他科室相比，儿科重症监护项目中随叫随到的情况更为常见（P <.001）。27%的 PD 报告说有经过重症监护培训的高级执业护士。大多数受访者认为，24/7 覆盖将与 ICU 中的更好的患者护理和对研究员的更好的教育相关联，尽管他们中的 65%认为这种模式会对培训生的自主权产生负面影响。
在对我们的调查做出回应的美国学术中心，重症监护医师 24/7 覆盖并不常见。重症监护医学专业之间似乎存在覆盖模式的显著差异。项目主任和培训生受访者认为 24/7 覆盖与更好的结果和教育相关联，但也对该模式对研究员自主权的影响表示担忧。
