CRITICAL CARE MEDICINE - OBSERVATIONS FRONT THE DEPARTMENT-OF-VETERANS-AFFAIRS INTENSIVE-CARE UNITS

Objectives: To study the critical care medicine programs of the Depart ment of Veterans Affairs. Design: Survey study. Setting: Data were obt ained from 85% (113/ 133) of the acute care hospitals of the Departmen t of Veterans Affairs. Main Measures: Intensive care unit (ICU) admini strative and patient demographics, physician training and certificatio n, participation in critical care medicine programs and research. Resu lts: Analyses were performed on 78% (2021) of Department of Veterans A ffairs' ICU beds. Mortality (%) was highest in medical ICUs (11.7 +/- 0.8) and lowest in coronary care units (5.0 +/- 0.5) and surgical ICUs (5.5 +/- 0.5). The average length of stay (days) was highest in medic al ICUs (5.6 +/- 0.6) and lowest in combined medical-coronary care uni ts (4.2 +/- 0.4) and coronary care units (4.3 +/- 0.5). The majority o f ICU directors have internal medicine training. A minority of ICU dir ectors are formally trained in critical care medicine or are board eli gible or certified in critical care medicine. The majority of fellows in the ICU are pulmonary or cardiac fellows; a minority are critical c are medicine fellows. Accredited critical care medicine fellowship tra ining programs were found in only 17% (19/113) of responding Departmen t of Veterans Affairs' institutions. Seventy-three percent (82/113) of ICUs in responding hospitals had published fewer than five publicatio ns between 1987 and 1990. Conclusions: The results of this study sugge st that the Department of Veterans Affairs would benefit from increasi ng the number of critical care medicine board eligible/certified direc tors, and increasing the program's participation in accredited critica l care medicine fellowship training programs and research endeavors. O verall, however, we conclude that the Department of Veterans Affairs' critical care medicine program is at least comparable to nationwide IC Us in the parameters evaluated.