Critical care medicine: Observations from the Department of Veterans Affairs' intensive care units

Objectives: To study the critical care medicine programs of the Department of Veterans Affairs. Design: Survey study. Setting: Data were obtained from 85% (113/133) of the acute care hospitals of the Department of Veterans Affairs. Main Measures: Intensive care unit (ICU) administrative and patient demographics, physician training and certification, participation in critical care medicine programs and research. Results: Analyses were performed on 78% (2021) of Department of Veterans Affairs' ICU beds. Mortality (%) was highest in medical ICUs (11.7 ± 0.8) and lowest in coronary care units (5.0 ± 0.5) and surgical ICUs (5.5 ± 0.5). The average length of stay (days) was highest in medical ICUs (5.6 ± 0.6) and lowest in combined medical-coronary care units (4.2 ± 0.4) and coronary care units (4.3 ± 0.5). The majority of ICU directors have internal medicine training. A minority of ICU directors are formally trained in critical care medicine or are board eligible or certified in critical care medicine. The majority of fellows in the ICU are pulmonary or cardiac fellows; a minority are critical care medicine fellows. Accredited critical care medicine fellowship training programs were found in only 17% (19/113) of responding Department of Veterans Affairs' institutions. Seventy- three percent (82/113) of ICUs in responding hospitals had published fewer than five publications between 1987 and 1990. Conclusions: The results of this study suggest that the Department of Veterans Affairs would benefit from increasing the number of critical care medicine board eligible/certified directors, and increasing the program's participation in accredited critical care medicine fellowship training programs and research endeavors. Overall, however, we conclude that the Department of Veterans Affairs' critical care medicine program is at least comparable to nationwide ICUs in the parameters evaluated.