Halpern N A, Wang J K, Alicea M, Greenstein R
Department of Surgery, VA Medical Center, Bronx, NY 10468.
Crit Care Med. 1994 Dec;22(12):2008-12.
To study the critical care medicine programs of the Department of Veterans Affairs.
Survey study.
Data were obtained from 85% (113/133) of the acute care hospitals of the Department of Veterans Affairs.
Intensive care unit (ICU) administrative and patient demographics, physician training and certification, participation in critical care medicine programs and research.
Analyses were performed on 78% (2021) of Department of Veterans Affairs' ICU beds. Mortality (%) was highest in medical ICUs (11.7 +/- 0.8) and lowest in coronary care units (5.0 +/- 0.5) and surgical ICUs (5.5 +/- 0.5). The average length of stay (days) was highest in medical ICUs (5.6 +/- 0.6) and lowest in combined medical-coronary care units (4.2 +/- 0.4) and coronary care units (4.3 +/- 0.5). The majority of ICU directors have internal medicine training. A minority of ICU directors are formally trained in critical care medicine or are board eligible or certified in critical care medicine. The majority of fellows in the ICU are pulmonary or cardiac fellows; a minority are critical care medicine fellows. Accredited critical care medicine fellowship training programs were found in only 17% (19/113) of responding Department of Veterans Affairs' institutions. Seventy-three percent (82/113) of ICUs in responding hospitals had published fewer than five publications between 1987 and 1990.
The results of this study suggest that the Department of Veterans Affairs would benefit from increasing the number of critical care medicine board eligible/certified directors, and increasing the program's participation in accredited critical care medicine fellowship training programs and research endeavors. Overall, however, we conclude that the Department of Veterans Affairs' critical care medicine program is at least comparable to nationwide ICUs in the parameters evaluated.
研究退伍军人事务部的重症医学项目。
调查研究。
数据来自退伍军人事务部85%（113/133）的急症医院。
重症监护病房（ICU）的管理和患者人口统计学特征、医生培训与认证、参与重症医学项目及研究情况。
对退伍军人事务部78%（2021张）的ICU床位进行了分析。内科ICU的死亡率（%）最高（11.7±0.8），冠心病监护病房（5.0±0.5）和外科ICU（5.5±0.5）的死亡率最低。平均住院天数在内科ICU最长（5.6±0.6），在内科 - 冠心病联合监护病房（4.2±0.4）和冠心病监护病房（4.3±0.5）最短。大多数ICU主任接受过内科培训。少数ICU主任接受过重症医学的正规培训或具备重症医学委员会资格认证。ICU的大多数住院医师是肺科或心脏科住院医师；少数是重症医学住院医师。在回复的退伍军人事务部机构中，只有17%（19/113）设有经认可的重症医学住院医师培训项目。回复医院中73%（82/113）的ICU在1987年至1990年间发表的论文少于5篇。
本研究结果表明，退伍军人事务部增加具备重症医学委员会资格/认证的主任数量，以及增加该项目参与经认可的重症医学住院医师培训项目和研究工作，将从中受益。然而，总体而言，我们得出结论，退伍军人事务部的重症医学项目在评估参数方面至少与全国范围内的ICU相当。
