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The critical care crisis in the United States: A report from the profession

Kelley, Mark A. MD, FCCP; Angus, Derek C. MB, ChB, FCCP, FCCM; Chalfin, Donald B. MD, MS, FCCP, FCCM; Crandall, Edward D. PhD, MD, FCCP; Ingbar, David MD, FCCP; Johanson, Wanda RN, MN; Medina, Justine RN, MS; Sessler, Curtis N. MD, FCCP, FCCM; Vender, Jeffery S. MD, FCCP, FCCM

doi: 10.1097/01.CCM.0000126403.89958.80
Special Articles

Background: The demand for critical care services in the United States is likely to increase as a result of the aging of the population and standards from the Leapfrog Group for intensivist physician staffing. However, the demand for critical care physicians, nurses, and other health professionals will significantly outpace supply because of severe shortages.

Participants: This article summarizes recommendations from the Framing Options for Critical Care in the United States (FOCCUS) Task Force, a group comprised of representatives from the Society of Critical Care Medicine, the American Association of Critical-Care Nurses, the College of Chest Physicians, and the American Thoracic Society, to prevent a crisis in American critical care services.

Data Sources and Process: Relevant literature was systematically searched by the representatives of each of the professional societies and synthesized with other sources, including official policy statements and guidelines from each of the professional societies, published review articles, expert opinion, nonrandomized historical cohort investigations, and other pertinent studies and sources. Consensus to identify the likely causes of the impending shortfall in critical care personnel, approaches to redesign of critical care practice, and the promotion of critical care excellence was reached via collaboration in direct meetings, telephone conferences, and electronic communications. Four major recommendations were subsequently agreed on to address the projected shortfall in critical care professionals and to improve the quality of critical care delivery.

Conclusions: The future demand for critical care services will likely exceed the capacities of the current delivery system. The professional societies and policy makers need to expeditiously intervene and act on these recommendations to ensure that the delivery of critical care services and care to the critically ill does not suffer.

American Thoracic Society, Henry Ford Health System, Detroit, MI, Society of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, Society of Critical Care Medicine, Montefiore Medical Center, Bronx, NY, American Thoracic Society, University of Southern California, Los Angeles, CA, American Thoracic Society, University of Minnesota, Minneapolis, MN, American Association of Critical Care Nurses, Aliso Viejo, CA, American Association of Critical Care Nurses, Aliso Viejo, CA, American College of Chest Physicians, Virginia Commonwealth University Health System, Richmond, VA, American College of Chest Physicians, Evanston Northwestern Healthcare, Evanston, IL

This article originally appeared in Chest (Chest 2004; 125:1514–1517) and is reprinted with permission from the American College of Chest Physicians.

© 2004 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins