Surgical intensive care: current perceptions and problems.

Abstract

To ascertain the problems and needs of surgical ICUs, questionnaires (prepared by the author) were submitted to 50 medical directors and ICU head nurses at major hospital centers throughout the country. Is there a demand for intensive care not being met? If so, why? What is the frequency of overcrowding or need for triage? Thirty-one of the 50 questionnaires were returned, most fully completed. Demographic information about the hospital and surgical ICU itself was obtained. In most hospitals, patients requiring elective surgery and who need postoperative intensive care were not canceled even though no ICU bed was available. The major factor which limited surgical ICU caseload was the lack of ICU nurses needed to manage the volume of patients requiring intensive care in already existing beds and with equipment already purchased and in use. The current nurse:patient staffing ratios are approximately 1:2 in most ICUs. Nurse staffing averaged 82% of the authorized complement (range 15-50%). The ICU nursing turnover rate was extremely variable, ranging from 50-75% per year in seven units to as low as less than 15% in six units. This survey suggests that both large and small hospitals have difficulty carrying out their surgical ICU mission because of the demand for more ICU facilities is outstripping the supply of ICU staff. The medical and nursing critical care societies must address these problems and attempt to solve them.