Editor's Note
This issue deals with two key topics in the ongoing discussion about how critical care should be organized: rapid response systems (also called medical emergency teams or rapid response teams) for identifying patients not in ICUs who are at risk for life-threatening deterioration, and around-the-clock intensivist staffing in the ICU. The first of these topics is the subject of two abstract/commentaries highlighting both the importance and the unclear status of rapid response systems. Dr. Ruth Kleinpell summarizes an important new study from Sweden that found significant decreases in cardiac arrests and overall hospital mortality after a rapid response system was implemented. She points out that while improvements in the process of care associated with the introduction of such systems are clearly beneficial, the quality of the evidence supporting them needs improvement. This conclusion is emphasized by new contributing editor Michael Young, MD, who reviews a new meta-analysis of available studies on rapid response teams. Noting important gaps and design deficiencies in the studies comprising this literature, Dr. Young points out several important questions that are yet to be answered before the value of such teams can be considered established.
The second topic relating to ICU organization is whether all ICUs should have on-site intensivist coverage around the clock, seven days a week (24/7), the subject of a pro-con special feature. The presence of qualified intensivists in the ICU is associated with better patient outcomes. Given this, it stands to reason that having them present 24/7 would be the ideal medical staffing arrangement for the ICU. However, financial constraints, a substantial shortage of intensivists, and other considerations make this matter far from settled. Summarizing the pros and cons of 24/7 intensivist staffing, I describe some alternative staffing options that are currently being employed, and refer to several additional organizational measures that have recently received attention.
David J Pierson, MD
This issue deals with two key topics in the ongoing discussion about how critical care should be organized: rapid response systems (also called medical emergency teams or rapid response teams) for identifying patients not in ICUs who are at risk for life-threatening deterioration, and around-the-clock intensivist staffing in the ICU.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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