Intensive care medicine in Europe

Healthcare Professionals' Expectations of Medical Artificial Intelligence and Strategies for its Clinical Implementation: A Qualitative Study

OBJECTIVES

Although medical artificial intelligence (AI) systems that assist healthcare professionals in critical care settings are expected to improve healthcare, skepticism exists regarding whether their potential has been fully actualized. Therefore, we aimed to conduct a qualitative study with physicians and nurses to understand their needs, expectations, and concerns regarding medical AI; explore their expected responses to recommendations by medical AI that contradicted their judgments; and derive strategies to implement medical AI in practice successfully.

METHODS

Semi-structured interviews were conducted with 15 healthcare professionals working in the emergency room and intensive care unit in a tertiary teaching hospital in Seoul. The data were interpreted using summative content analysis. In total, 26 medical AI topics were extracted from the interviews. Eight were related to treatment recommendation, seven were related to diagnosis prediction, and seven were related to process improvement.

RESULTS

While the participants expressed expectations that medical AI could enhance their patients' outcomes, increase work efficiency, and reduce hospital operating costs, they also mentioned concerns regarding distortions in the workflow, deskilling, alert fatigue, and unsophisticated algorithms. If medical AI decisions contradicted their judgment, most participants would consult other medical staff and thereafter reconsider their initial judgment.

CONCLUSIONS

Healthcare professionals wanted to use medical AI in practice and emphasized that artificial intelligence systems should be trustworthy from the standpoint of healthcare professionals. They also highlighted the importance of alert fatigue management and the integration of AI systems into the workflow.

Critical Care Junior Doctors' Profile in a Lower Middle-income Country: A National Cross-sectional Survey

Background and Aims:

Retention of junior doctors in specialties such as critical care is difficult, especially in resource-limited settings. This study describes the profile of junior doctors in adult state intensive care units in Sri Lanka, a lower middle-income country.

Materials and Methods:

This was a national cross-sectional survey using an anonymous self-administered electronic questionnaire.

Results:

Five hundred and thirty-nine doctors in 93 Intensive Care Units (ICUs) were contacted, generating 207 responses. Just under half of the respondents (93, 47%) work exclusively in ICUs. Most junior doctors (150, 75.8%) had no previous exposure to anesthesia and 134 (67.7%) had no previous ICU experience while 116 (60.7%) ICU doctors wished to specialize in critical care. However, only a few (12, 6.3%) doctors had completed a critical care diploma course. There was a statistically significant difference (P < 0.05) between the self-assessed confidence of anesthetic background junior doctors and non-anesthetists. The overall median competency for doctors improves with the length of ICU experience and is statistically significant (P < 0.05). ICU postings were less happy and more stressful compared to the last non-ICU posting (P < 0.05 for both). The vast majority, i.e., 173 (88.2%) of doctors felt the care provided for patients in their ICUs was good, very good, or excellent while 71 doctors (36.2%) would be happy to recommend the ICU where they work to a relative with the highest possible score of 10.

Conclusion:

Measures to improve training opportunities for these doctors and strategies to improve their retention in ICUs need to be addressed.

A cross-sectional survey of critical care services in Sri Lanka: a lower middle-income country

PURPOSE

To describe the extent and variation of critical care services in Sri Lanka as a first step towards the development of a nationwide critical care unit (CCU) registry.

MATERIALS AND METHODS

A cross-sectional survey was conducted in all state CCUs by telephone or by visits to determine administration, infrastructure, equipment, staffing, and overall patient outcomes.

RESULTS

There were 99 CCUs with 2.5 CCU beds per 100000 population and 13 CCU beds per 1 000 hospital beds. The median number of beds per CCU was 5. The overall admissions were 194 per 100000 population per year. The overall bed turnover was 76.5 per unit per year, with CCU mortality being 17%. Most CCUs were headed by an anesthetist. There were a total of 790 doctors (1.6 per bed), 1,989 nurses (3.9 per bed), and 626 health care assistants (1.2 per bed). Majority (87.9%) had 1:1 nurse-to-patient ratio, although few (11.4%) nurses had received formal intensive care unit training. All CCUs had basic infrastructure (electricity, running water, piped oxygen) and basic equipment (such as electronic monitoring and infusion pumps).

CONCLUSION

Sri Lanka, a lower middle-income country has an extensive network of critical care facilities but with inequalities in its distribution and facilities.

Current status of intensive care units registered as critical care subspecialty training hospitals in Korea

There is a lack of information on critical care in Korea. The aim of this study was to determine the current status of Korean intensive care units (ICUs), focusing on the organization, characteristics of admitted patients, and nurse and physician staffing. Critical care specialists in charge of all 105 critical care specialty training hospitals nationwide completed a questionnaire survey. Among the ICUs, 56.4% were located in or near the capital city. Only 38 ICUs (17.3%) had intensive care specialists with a 5-day work week. The average daytime nurse-to-patient ratio was 1:2.7. Elderly people ≥ 65 yr of age comprised 53% of the adult patients. The most common reasons for admission to adult ICUs were respiratory insufficiency and postoperative management. Nurse and physician staffing was insufficient for the appropriate critical care in many ICUs. Staffing was worse in areas outside the capital city. Much effort, including enhanced reimbursement of critical care costs, must be made to improve the quality of critical care at the national level.

International comparisons of intensive care: informing outcomes and improving standards

PURPOSE OF REVIEW

Interest in international comparisons of critical illness is growing, but the utility of these studies is questionable. This review examines the challenges of international comparisons and highlights areas in which international data provide information relevant to clinical practice and resource allocation.

RECENT FINDINGS

International comparisons of ICU resources demonstrate that definitions of critical illness and ICU beds vary due to differences in ability to provide organ support and variable staffing. Despite these limitations, recent international data provide key information to understand the pros and cons of different availability of ICU beds on patient flow and outcomes, and also highlight the need to ensure long-term follow-up due to heterogeneity in discharge practices for critically ill patients. With increasing emphasis on curbing costs of healthcare, systems that deliver lower cost care provide data on alternative options, such as regionalization, flexible allocation of beds, and bed rationing.

SUMMARY

Differences in provision of critical care can be leveraged to inform decisions on allocation of ICU beds, improve interpretation of clinical outcomes, and assess ways to decrease costs of care. International definitions of key components of critical care are needed to facilitate research and ensure rigorous comparisons.

A unique snapshot of intensive care resources in Australia and New Zealand

The objective of this study was to analyse and report on the distribution and attributes of intensive care services in Australia and New Zealand for the 2005/2006 financial year A survey was mailed to 155 Australian and 26 New Zealand intensive care units (ICU) listed on the database of the Australian and New Zealand Intensive Care Society. A descriptive analytical approach was used. Of the 181 ICUs, 177 provided data. In Australia there were 100 public sector and 51 private sector ICUs and in New Zealand, 24 public sector and two private sector ICUs. These units contain 1485 available beds in the public sector and 538 available beds in the private sector Calculations to determine beds per 100,000 population, medical specialists per 1000 patient days and registered nurses per 1000 patient days showed wide variation. International comparisons are limited by lack of data; however it does appear that intensive care patients in Australia and New Zealand have very good outcomes.

Physician staffing models and patient safety in the ICU

Despite the manpower shortage to care for the critically ill, the number of ICU beds has been rising for the last 2 decades. The ICU intensivist physician staffing model is still in flux in this country. Despite a challenge by a recent single publication, numerous studies have shown that high-intensity intensivist staffing improves patient outcome in the ICU. However, 73% of the ICUs in this country provide low-intensity or no intensive care coverage. Although it may not be possible to implement 24 h/d intensivist coverage of all ICUs at this time, we believe it is the best model for achieving good patient outcome. The mere presence of intensivists in the ICU is unlikely to improve patient outcome unless it is associated with the creation of an organizational environment ideal for the implementation of evidence-based practice. In this commentary, we will discuss the available evidence behind the current models and express our opinions about current and future ICU intensivist staffing.