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A recent Department of Health & Human Services report revealed that two-thirds of patients needing critical care services may be receiving suboptimal care. The reason? The current demand for critical care services has surpassed the supply of critical care specialists (intensivists) needed to provide optimal care. The report projects that this problem will be even more severe by 2020 due to the aging population and the increased utilization of intensivists.
The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians predicts a 35% shortage of, and subsequent demand for, intensivists by 2020. The report reinforces findings that the involvement of intensivists improves outcomes for critically ill patients and suggests an imminent need to increase the intensivist supply.
The report goes on to cite the estimated 360,000 deaths occurring each year in intensive care units (ICUs) not managed by intensivists. Increasing the intensivist supply could save up to 54,000 lives annually, the report concludes.
Stephen Eckel, Pharm.D., assistant director of pharmacy at University of North Carolina Hospitals in Durham, believes that the shortage of critical care specialists presents a unique opportunity for pharmacy to continue demonstrating the value that they bring to patients.
"Beyond preventing medication errors, minimizing drug costs through promoting optimal therapy, and managing the complex antimicrobial regimens in these patients, pharmacists can position themselves to address other roles," Eckel said. He explained that this could occur by managing certain disease states through protocol (ensuring that current guidelines are being optimized) and assuming other unrecognized roles. Eckel hopes that pharmacy will recognize and prepare for this impending shortage by working with their colleagues from the other disciplines to help in meeting the needs of critical care patients. "Collaboration," asserted Eckel, "will be the key to success over the next few years."
CAMC is attempting to make advances with the critical care population by employing an automatic clinical pharmacy consult for early goal-directed therapy for patients with sepsis. "Our pharmacy on-call service is consulted, and they work at the bedside with the team caring for the patient," Spence noted. Although results are difficult to measure qualitatively, the service has measured the impact quantitatively and seen some impact to the pharmacy's finances.
According to data from the HHS report, U.S. patients account for approximately 18 million ICU days annually, and more than half of these days have been associated with care for patients older than 65 years. Between 2000 and 2020, the population under age 65 is expected to grow by 10%; the population age 65 and older is expected to grow by approximately 50% by 2020 and 100% by 2030. As a result, the growth of the aging population alone will increase the demand for adult critical care services by approximately 38% between 2000 and 2020.
The current utilization of intensivists to provide critical care services is expected to remain the same. To increase the supply of critical care professionals, the report's authors recommend expanding opportunities for U.S.-trained international medical graduates to practice in the United States and increasing medical and nursing school capacity to train critical care providers.