What Does it Take to Run an ICU and Perioperative Medicine Service?

Abstract

Promoting an intensive care unit (ICU) or perioperative “brand” helps establish the needs and the goals for the service. Critical care does not have the same tangible outputs that define many medical specialties. Service lines are based on expected throughput from clinical services. ICU goals, such as meeting extubation milestones and following fluid protocols, support these outputs, but are distinct. It is a mistake to view critical care as a simple extension of service lines. Administrators and clinicians who are not involved directly in critical care practice can underestimate the mission and operations of a highly functioning critical care service. Absent a clear mission, an ICU will struggle to define itself against misaligned expectations and misguided efficiency accountabilities. It is easy to convey the need for an ICU to a medical center, but a challenge to articulate the nature of that need and the benefits to be gained in the context of other hospital operations. ICU care is essential to the provision of complex care, and understanding the fragile physiology of critically ill patients and their susceptibility to complications requires special training and ongoing experience. Sick patients require adequate levels of staffing, monitoring, coordination, and collaboration. These are the defining criteria of ICU level of care. However, this narrow definition draws no distinction