REGIONALIZATION OF CRITICAL CARE MEDICINE - TASK-FORCE REPORT OF THE AMERICAN-COLLEGE-OF-CRITICAL-CARE-MEDICINE

Objectives: To review the existing literature and task force opinions on regionalization of critical care services, and to synthesize a judgment on possible costs, benefits, disadvantages, and strategies. Data Sources: Pertinent literature in the English language. Study Selection: One hundred forty-six English language papers were studied to determine possible ramifications of regionalization of critical care or other similar services. Data Extraction: Information on possible influence on the care of the critically ill was sought and integrated with the opinions of task force members. Possible costs, benefits, as well as disadvantages to the patient, transferring and receiving institutions, and region as a whole were sought. Data Synthesis: Regionalization of critical care services was thought to be advantageous to the patient. The larger academic institutions tend to have more resources, better subspecialty availability, and expertise in the care of the critically ill. Efficiency and safety during transport need to be in place. Disadvantages of overutilization, possible costliness to both the referring institution as well as to the receiving institution were outlined. It was agreed that pediatric critical care medicine was a separate issue. Conclusions: Regionalization of critical care medicine probably is beneficial and the concept should be explored.