Critical care is starting to face some tough obstacles, and the ICU of the future will be shaped by these problems—namely an aging population and a shrinking field of expert critical care practitioners. Because of these impending changes, in 20 or 30 years your hospital’s ICU must look different and work differently in order to handle a steady influx of critically ill patients.
This installment of our “Hospital of the Future” series will examine how the hospital of the future will deal effectively with the supply-and-demand quandary that is already becoming apparent in the ICU. It will also examine future possibilities for staffing structure, introduction of critical care guidelines, and groundbreaking technical solutions. Prospects for critical care may look questionable now, but solutions are available. And the future just might be brighter than expected.
Supply and Demand of Critical Care Demands Change
Current trends in both the U.S. population and the demographics of critical care staff dictate that critical care must change—and fast. With millions of baby boomers aging, demand for critical care facilities within hospitals will increase.
“There’s little question that critical care is used disproportionately by the elderly,” says Timothy Buchman, MD, PhD, FACS, FCCM, past president of the Society of Critical Care Medicine (SCCM) and professor at Washington University School of Medicine, St. Louis. “The demand can only increase as the population ages.”
At the same time, there are already too few critical care providers in the United States. “If we designed an ideal ICU for every hospital in the country, we could only staff about one-third of them” right now, says Thomas Rainey, MD, FCCM, president, CriticalMed, Inc., Bethesda, Md.
Critical care experts are, of course, the key to quality care in the ICU. But the population of both specially trained intensivists and experienced ICU nurses is declining. The average age of an ICU nurse is now 47, and they are not replaced fast enough.
“Critical care nursing is brutally hard work; it’s physically, emotionally, and spiritually grueling,” points out Dr. Buchman. “The challenge is keeping experienced nurses from leaving because they’re burned out. We need to keep their knowledge and experience, possibly by creating new positions where their knowledge, experience, and accumulated wisdom can be used to benefit the next generations of patients and providers.”
As for physicians, fewer are choosing critical care, which will likely lead to significant staffing issues. “The number of doctors choosing a career in critical care is leveling off,” says Dr. Buchman. Part of the problem is an educational system that helps medical students choose a specialty.
“We have a direct training path to many specialties through residencies,” he says. “There is no residency in critical care medicine. Instead, we ask people to initially train as something else. We’ve created an educational barrier.”
The upshot of these trends, says Dr. Rainey, is that “the graying population and the loss of [critical care] staff is a collision waiting to happen.”
Dr. Buchman adds, “The question is: How do people organize themselves and leverage technology to address this gap and improve the quality of care?”
How Technology Fits In
In 2001, Richard L. Craft, MSEE, wrote of “Trends in Technology and the Future Intensive Care Unit” ( . 2001;29[8 suppl]): “ … advances in networking are likely to redefine the physical and organizational boundaries of the critical care unit. No longer a self-contained entity … tomorrow’s critical care units are likely to regularly draw on resources—both human and technological—located outside the unit’s physical space.”