Abstract
Introduction
Intensive care unit (ICU) patient and provider attributes may prompt specialty consultation.
We sought to determine practice patterns of surgical critical care (SCC) physicians
for ICU consultation.
Methods
We surveyed American Association for the Surgery of Trauma members. Various diagnoses
were listed under each of nine related specialties. Respondents were asked for which
conditions they would consult a specialist. Conditions were cross-referenced with
the SCC fellowship curriculum. Other perspectives on practice and consultation were
queried.
Results
314 physicians (18.6%) responded (68% male; 79% White; 96.2% surgical intensivist);
284 (16.8%) completed all questions. Percentage of clinical time practicing SCC was
26-50% in 57% and >50% in 14.5%. ICUs were closed (39%), open (25%), or hybrid (36%).
Highest average confidence ratings (1 = least, 5 = most) for managing select conditions
were ventilator, 4.64; palliative care, 4.51; infections, 4.44; organ donation, hemodynamics
(tie), 4.31; lowest rating was myocardial ischemia, 3.85. Consults were more frequent
for Cardiology, Hematology, and Neurology; less frequent for nephrology, palliative
care, gastroenterology, infectious disease, and pulmonary; and low for curriculum
topics (<25%) except for infectious diseases and palliative care. Attending staffing
24 h/day was associated with a lower mean number of topics for consultation (mean
24.03 versus 26.31, P = 0.015).
Conclusions
ICU consultation practices vary based on consultant specialty and patient diagnosis.
Consultation is most common for specialty-specific diseases and specialist interventions,
but uncommon for topics found in the SCC curriculum, suggesting that respondents’
scope of practice closely matched their training.
Keywords
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Article info
Publication history
Published online: March 20, 2023
Accepted:
February 17,
2023
Received in revised form:
January 16,
2023
Received:
July 31,
2022
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
