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Special Communication |

Providing Care for Critically Ill Surgical Patients:  Challenges and Recommendations

Samuel A. Tisherman, MD1; Lewis Kaplan, MD2; Vicente H. Gracias, MD3; Gregory J. Beilman, MD4; Christine Toevs, MD5; Matthew C. Byrnes, MD4; Craig M. Coopersmith, MD6 ; for the Surgery Section, Society of Critical Care Medicine
[+] Author Affiliations
1Departments of Critical Care Medicine and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
2Department of Surgery, Yale School of Medicine, Yale University, New Haven, Connecticut
3Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark
4Department of Surgery, University of Minnesota Medical School, Minneapolis
5Department of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
6Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
JAMA Surg. 2013;148(7):E1-E6. doi:10.1001/jamasurg.2013.1208.
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Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed.

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Factors That May Influence the Ability to Provide the Intensivist Model of Care in Surgical Intensive Care Units
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