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Flynn BC, Hicks MH, Jabaley CS, Simmons S, Maxey-Jones C, Moitra V, Brown D, Khanna AK, Kidd B, Chow J, Golhar SY, Hemati K, Ben-Jacob TK, Kaufman M, Cobas M, Nurok M, Williams G, Nunnally ME. Sustainability of the Subspecialty of Anesthesiology Critical Care: An Expert Consensus and Review of the Literature. J Cardiothorac Vasc Anesth 2024; 38:1753-1759. [PMID: 38834447 DOI: 10.1053/j.jvca.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 06/06/2024]
Abstract
While considerable literature exists with respect to clinical aspects of critical care anesthesiology (CCA) practice, few publications have focused on how anesthesiology-based critical care practices are organized and the challenges associated with the administration and management of anesthesiology critical care units. Currently, numerous challenges are affecting the sustainability of CCA practice, including decreased applications to fellowship positions and decreased reimbursement for critical care work. This review describes what is known about the subspecialty of CCA and leverages the experience of administrative leaders in adult critical care anesthesiologists in the United States to describe potential solutions.
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Affiliation(s)
- Brigid C Flynn
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS.
| | - Megan H Hicks
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Shawn Simmons
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | | | - Vivek Moitra
- Department of Anesthesiology, Columbia University Medical Center, New York, NY
| | - Dan Brown
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Ashish K Khanna
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Brent Kidd
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS
| | - Jarva Chow
- Department of Anesthesiology, University of Chicago, Chicago, IL
| | - Shweta Yemul Golhar
- Department of Anesthesiology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA
| | - Kaveh Hemati
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA
| | - Talia K Ben-Jacob
- Cooper Medical School of Rowan University, Critical Care, Department of Anesthesiology, Cooper University Hospital, Camden, NJ
| | - Margit Kaufman
- Department of Anesthesiology, Northern Valley Anesthesia/TeamHealth Englewood Health, Englewood NJ
| | - Miguel Cobas
- Department of Anesthesiology, University of Miami School of Medicine, Palmetto Bay, FL
| | - Michael Nurok
- Department of Anesthesiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - George Williams
- Department of Anesthesiology, Memorial Hermann Hospital, Texas Medical Center, Houston, TX
| | - Mark E Nunnally
- Department of Anesthesiology, Perioperative Care & Pain Medicine, Neurology, Surgery and Medicine, New York University, New York, NY
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Tameze Y, Shelton KT. Racial and Ethnic Disparities in Cardiovascular Care: Role of the Clinician-A Response. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00402-6. [PMID: 39004567 DOI: 10.1053/j.jvca.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Affiliation(s)
- Yasmine Tameze
- Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kenneth T Shelton
- Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Nurok M, Flynn BC, Pineton de Chambrun M, Kazemian M, Geiderman J, Nunnally ME. A Review and Discussion of Full-Time Equivalency and Appropriate Compensation Models for an Adult Intensivist in the United States Across Various Base Specialties. Crit Care Explor 2024; 6:e1064. [PMID: 38533294 PMCID: PMC10965199 DOI: 10.1097/cce.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES Physicians with training in anesthesiology, emergency medicine, internal medicine, neurology, and surgery may gain board certification in critical care medicine upon completion of fellowship training. These clinicians often only spend a portion of their work effort in the ICU. Other work efforts that benefit an ICU infrastructure, but do not provide billing opportunities, include education, research, and administrative duties. For employed or contracted physicians, there is no singular definition of what constitutes an intensive care full-time equivalent (FTE). Nevertheless, hospitals often consider FTEs in assessing hiring needs, salary, and eligibility for benefits. DATA SOURCES Review of existing literature, expert opinion. STUDY SELECTION Not applicable. DATA EXTRACTION Not applicable. DATA SYNTHESIS Not applicable. CONCLUSIONS Understanding how an FTE is calculated, and the fraction of an FTE to be assigned to a particular cost center, is therefore important for intensivists of different specialties, as many employment models assign salary and benefits to a base specialty department and not necessarily the ICU.
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Affiliation(s)
- Michael Nurok
- Departments of Anesthesiology, Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Brigid C Flynn
- Division of Critical Care, Department of Anesthesiology, University of Kansas Health System, Kansas City, KS
| | - Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, APHP, Sorbonne Université, Paris, France
- INSERM-UMRS 1166, iCAN Institute of Cardiometabolism/Nutrition, Sorbonne Université, Paris, France
| | - Mina Kazemian
- Department of Anesthesiology, Riverside University, Riverside, CA
| | - Joel Geiderman
- Ruth and Harry Roman Emergency Department, Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mark E Nunnally
- Department of Anesthesiology, Perioperative Care and Pain Medicine, Neurology, Surgery and Medicine, NYU Langone Health, NYU School of Medicine, New York, NY
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Kaniecki DM, Grabowski RL, Holloway D, Brown A, Lorenz LA. Nurse Practitioners in Critical Care Transport. Air Med J 2024; 43:163-167. [PMID: 38490781 DOI: 10.1016/j.amj.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/04/2023] [Accepted: 01/04/2024] [Indexed: 03/17/2024]
Abstract
The inclusion of nurse practitioners (NPs) in critical care transport teams has the potential to enhance patient care and improve team operations. NPs can manage complex clinical situations during transport and excel in various roles such as leadership, education, mentoring, research, quality improvement, and clinical expertise. As we navigate the evolving landscape of critical care transport, it is crucial to explore the potential benefits offered by NPs. Their distinct skills and experiences effectively position them to improve patient outcomes, enhance team performance, and contribute to health care's financial sustainability. This article discusses the role of NPs in critical care transport, providing insight into their current uses, and recommendations for optimal use.
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Affiliation(s)
- David M Kaniecki
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH; Cleveland Metro Life Flight, MetroHealth System, Cleveland, OH.
| | - Robert L Grabowski
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH; Cleveland Metro Life Flight, MetroHealth System, Cleveland, OH
| | - David Holloway
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH; Cleveland Clinic Critical Care Transport, Cleveland Clinic, Cleveland, OH
| | - Abigail Brown
- Cleveland Clinic Critical Care Transport, Cleveland Clinic, Cleveland, OH
| | - Lisa A Lorenz
- Cleveland Clinic Critical Care Transport, Cleveland Clinic, Cleveland, OH
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Mazzeffi M, Shelton K. Preparing Cardiothoracic Intensive Care Unit Leaders for Success. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00249-5. [PMID: 37147208 DOI: 10.1053/j.jvca.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/07/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Michael Mazzeffi
- University of Virginia Health, Department of Anesthesiology, Charlottesville, VA
| | - Kenneth Shelton
- Massachusetts General Hospital, Department of Anesthesia, Harvard Medical School, Boston, MA
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Flynn BC. Anesthesiology Critical Care: Current State and Future Directions. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00248-3. [PMID: 37164803 DOI: 10.1053/j.jvca.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/28/2023] [Accepted: 04/07/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Brigid C Flynn
- Department of Anesthesiology, Division of Critical Care, University of Kansas Medical Center, Kansas City, KS.
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Kopanczyk R, Lester J, Long MT, Kossbiel BJ, Hess AS, Rozycki A, Nunley DR, Habib A, Taylor A, Awad H, Bhatt AM. The Future of Cardiothoracic Surgical Critical Care Medicine as a Medical Science: A Call to Action. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:47. [PMID: 36676669 PMCID: PMC9867461 DOI: 10.3390/medicina59010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Cardiothoracic surgical critical care medicine (CT-CCM) is a medical discipline centered on the perioperative care of diverse groups of patients. With an aging demographic and an increase in burden of chronic diseases the utilization of cardiothoracic surgical critical care units is likely to escalate in the coming decades. Given these projections, it is important to assess the state of cardiothoracic surgical intensive care, to develop goals and objectives for the future, and to identify knowledge gaps in need of scientific inquiry. This two-part review concentrates on CT-CCM as its own subspeciality of critical care and cardiothoracic surgery and provides aspirational goals for its practitioners and scientists. In part one, a list of guiding principles and a call-to-action agenda geared towards growth and promotion of CT-CCM are offered. In part two, an evaluation of selected scientific data is performed, identifying gaps in CT-CCM knowledge, and recommending direction to future scientific endeavors.
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Affiliation(s)
- Rafal Kopanczyk
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Jesse Lester
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Micah T. Long
- Department of Anesthesiology, University of Wisconsin Hospitals & Clinics, Madison, WI 53792, USA
| | - Briana J. Kossbiel
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Aaron S. Hess
- Department of Anesthesiology and Pathology & Laboratory Medicine, University of Wisconsin Hospitals & Clinics, Madison, WI 53792, USA
| | - Alan Rozycki
- Department of Pharmacology, The Ohio State Wexner Medical Center, Columbus, OH 43210, USA
| | - David R. Nunley
- Department of Pulmonary, Critical Care & Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Alim Habib
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Ashley Taylor
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Hamdy Awad
- Department of Anesthesiology, Division of Cardiothoracic and Vascular Anesthesia, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Amar M. Bhatt
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Kopanczyk R, Long MT, Satyapriya SV, Bhatt AM, Lyaker M. Developing Cardiothoracic Surgical Critical Care Intensivists: A Case for Distinct Training. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1865. [PMID: 36557067 PMCID: PMC9784574 DOI: 10.3390/medicina58121865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
Cardiothoracic surgical critical care medicine is practiced by a diverse group of physicians including surgeons, anesthesiologists, pulmonologists, and cardiologists. With a wide array of specialties involved, the training of cardiothoracic surgical intensivists lacks standardization, creating significant variation in practice. Additionally, it results in siloed physicians who are less likely to collaborate and advocate for the cardiothoracic surgical critical care subspeciality. Moreover, the current model creates credentialing dilemmas, as experienced by some cardiothoracic surgeons. Through the lens of critical care anesthesiologists, this article addresses the shortcomings of the contemporary cardiothoracic surgical intensivist training standards. First, we describe the present state of practice, summarize past initiatives concerning specific training, outline why standardized education is needed, provide goals of such training standardization, and offer a list of desirable competencies that a trainee should develop to become a successful cardiothoracic surgical intensivist.
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Affiliation(s)
- Rafal Kopanczyk
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Micah T. Long
- Department of Anesthesiology, University of Wisconsin Hospitals & Clinics, Madison, WI 53792, USA
| | - Sree V. Satyapriya
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Amar M. Bhatt
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Michael Lyaker
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Kopanczyk R, Kumar N, Bhatt AM. A Brief History of Cardiothoracic Surgical Critical Care Medicine in the United States. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121856. [PMID: 36557057 PMCID: PMC9788562 DOI: 10.3390/medicina58121856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Cardiothoracic surgical intensive care has developed in response to advances in cardiothoracic surgery. The invention of the cardiopulmonary bypass machine facilitated a motionless and bloodless surgical field and made operations of increasing complexity feasible. By the mid-1950s, the first successful procedures utilizing cardiopulmonary bypass took place. This was soon followed by the establishment of postoperative recovery units, the precursors to current cardiothoracic surgical intensive care units. These developments fostered the emergence of a new medical specialty: the discipline of critical care medicine. Together, surgeons and intensivists transformed the landscape of acute, in-hospital care. It is important to celebrate these achievements by remembering the individuals responsible for their conception. This article describes the early days of cardiothoracic surgery and cardiothoracic intensive care medicine.
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Affiliation(s)
- Rafal Kopanczyk
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Correspondence:
| | - Nicolas Kumar
- Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Amar M. Bhatt
- Department of Anesthesiology, Division of Critical Care, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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