Acute and Critical Care

Original Article

Policy
Major Obstacles to Implement a Full-Time Intensivist in Korean Adult ICUs: a Questionnaire Survey: Jun Wan Lee, Jae Young Moon, Seok Wha Youn, Yong Sup Shin, Sang Il Park, Dong Chan Kim, Younsuk Koh; Korean J Crit Care Med. 2016;31(2):111-117. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.111; Correction in: Acute Crit Care 2016;31(3):262

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Background:
Critical care physician staffing is a crucial element of the intensive care unit (ICU) organization, and is associated with better outcomes in ICUs. Adult ICUs in Korea have been suffering from inadequate full-time intensivists and nurses because of insufficient reimbursement rates (<50% of the original critical care cost) from the National Health Insurance System. Recently, full-time intensivists have been introduced as a prerequisite for adult ICUs of tertiary hospitals in Korea. The purpose of this study was to examine the perception of intensivist staffing among critical care program directors regarding the barriers and solutions when implementing an intensivist model of critical care in Korea.
Methods
An email survey of critical care program directors in designated teaching hospitals for critical care subspecialty training by the Korean Society of Critical Care Medicine was performed. The survey domains included vision, culture, resources, barriers, and potential solutions to implementing intensivist physician staffing (IPS).
Results
Forty-two critical care program directors were surveyed. A total of 28 directors (66.7%) responded to email queries. Of these, 27 directors (96.4%) agreed that IPS would improve the quality of care in the ICU, although half of them reported a negative perception of relevant clinical colleagues for the role of full-time intensivists and poor resources for IPS in their hospitals. Increased financial burden due to hiring full-time intensivists and concerns regarding exclusion from the management of their critically ill patients in the ICU, together with loss of income for primary attending physicians were stated by the respondents to be major barriers to implementing IPS. Financial incentives for the required cost from the health insurance system and enhancement of medical law relevant to critical care were regarded as solutions to these issues.
Conclusions
Critical care program directors believe that intensivist-led critical care can improve the outcome of ICUs. They indicated the financial burden due to IPS and underestimation of a full-time intensivist’s role to be major barriers. The program directors agreed that a partnership between hospital leaders and the Ministry of Health and Welfare was needed to overcome these barriers.

Citations

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Incidence and Mortality Trends in Critically Ill Children: A Korean Population-Based Study
Jaeyoung Choi, Esther Park, Ah Young Choi, Meong Hi Son, Joongbum Cho
Journal of Korean Medical Science.2023;[Epub] CrossRef
Willingness to pay for family education and counselling services provided by critical care advanced practice nurses
Chung Mee Ko, Chin Kang Koh, Sangho Kwon
International Journal of Nursing Practice.2019;[Epub] CrossRef
Intensivist as a Surgeon: The Role of a Surgeon in Critical Care Medicine
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The Ewha Medical Journal.2017; 40(2): 61. CrossRef

Reviews

The Association of Nurse Staffing Levels and Patient Outcome in Intensive Care Units: Hyunjung Lee, Hongbeom Bae; Korean J Crit Care Med. 2013;28(2):75-79.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.75

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Abstract PDF

Nurses play a crucial role in providing high-quality care in intensive care units (ICU). Previous studies have shown an association between nurse staffing levels and outcome of critically ill patients. Increasing nurse staffing levels in ICU has been recommended to improve the outcome of critically ill patients. However, nursing staff shortages associated with decreased budgets may prevent adequate nurse-to-patient ratios although there lies increasing needs for critical care. Several studies have suggested that higher nurse staffing level is associated with favorable patient outcome, including mortality, length of stay, and infections, but some of studies did not find an association between nurse staffing and patient outcome. Although there are some controversies in the associations between nurse staffing levels and patient outcome, it is difficult to apply such effect as compared with other developed countries in North American and Europe as the nurse-to-patient ratio in Korea's ICU is relatively low. By studying the nurse staffing effects for patient outcome from the Korea ICU, it is found that higher nurse staffing level is associated with improved patient mortality. This finding may suggest that a shortage of nursing staff is currently a serious issue for caring of critically ill patients in Korea.

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Quantitative Evaluation of Evacuation Efficiency during Disasters according to the Operation of Human Resources in Medical Facilities
Junghyeon Kim, Moonsik Kim, Yongjoo Kim, Dongho Rie
Journal of the Korean Society of Hazard Mitigation.2024; 24(3): 97. CrossRef
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Ye Rim Kim, Hye Ree Park, Mee Kyung Shin
The Korean Journal of Rehabilitation Nursing.2023; 26(1): 28. CrossRef
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Intensivist Physician Staffing in Intensive Care Units: Sunghoon Park, Gee Young Suh; Korean J Crit Care Med. 2013;28(1):1-9.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.1

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Abstract PDF

Despite a shortage of intensivists, there is an increased need for intensivist staffing in intensive care units (ICUs). Western studies showed that the survival rate of critically ill patients improved and the length of ICU stay decreased in "closed" or "high-intensity" ICU, where intensivists dedicated themselves to the ICU and were primary physicians. This system was also associated with an increased compliance of evidence-based medicine and a decreased medical error. The Leapfrog Group and American College of Critical Care Medicine recommend the implementation of intensivist staffing system in the ICU. Although there are still barriers to implement this system, such as the economic burden to hospitals and conflicts among medical staff, intensivist staffing in the ICU is important in terms of timely diagnosis and treatment and multidisciplinary team approach. The presence of intensivists may also increase the efficacy of ICU systems and save treatment cost. Although the "24 hours/7 days intensivist staffing" system may be ideal, recent data showed that high-intensity ICU system during daytime is not inferior to 24-hour intensivist staffing system in terms of hospital mortality. It is especially important to large-scale academic hospitals, where many severely ill patients are treated. However, few ICUs have intensivists who are committed to caring for ICU patients in Korea. Therefore, we have to try to expand this system throughout the whole country. Additionally, the definition of ICU standard, the role of intensivists, and the policy of financial reward also need to be clarified more clearly.

Citations

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Effects of the presence of a pediatric intensivist on treatment in the pediatric intensive care unit
Jung Eun Kwon, Da Eun Roh, Yeo Hyang Kim
Acute and Critical Care.2020; 35(2): 87. CrossRef
Intensivist as a Surgeon: The Role of a Surgeon in Critical Care Medicine
Kyung Sook Hong
The Ewha Medical Journal.2017; 40(2): 61. CrossRef

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