The Intensive Care Unit Perspective of Becoming a Level I Trauma Center: Challenges of Strategy, Leadership, and Operations Management

Abstract

The primary purpose of this narrative is to elucidate the numerous significant changes that occur at the intensive care unit (ICU) level as a medical center pursues becoming a Level I trauma center. Specifically, we will focus on the following important areas: (1) leadership and strategy issues behind the decision to move forward with becoming a trauma center; (2) preparation needed to take a highly functioning surgical ICU and align it for the inevitable changes that happen as trauma go-live occurs; (3) intensivist staffing changes; (4) roles for and training of advanced practice practitioners; (5) graduate medical education issues; (6) optimizing interactions with closely related services; (7) nursing, staffing, and training issues; (8) bed allocation issues; and (9) reconciling the advantages of a “unified adult critical care service” with the realities of the central relationship between trauma and surgical critical care.

Optimizing combat readiness for military surgeons without trauma fellowship training: Engaging the “voluntary faculty” model

“…The NMTF staff surgeon is not trauma fellowship trained; therefore, they were not permitted to independently cover surgical ICU call at CTC (internal policy). This requirement is common among most major trauma centers and an American College of Surgeons requirement for all surgical ICU directors 11 . Furthermore, although not an explicit requirement, it is highly encouraged for all CTC providers covering trauma call to be fellowship trained in surgical critical care (Jacob Glaser, MD, Personal verbal communication, July 2021).…”

“…This requirement is common among most major trauma centers and an American College of Surgeons requirement for all surgical ICU directors. 11 Furthermore, although not an explicit requirement, it is highly encouraged for all CTC providers covering trauma call to be fellowship trained in surgical critical care (Jacob Glaser, MD, Personal verbal communication, July 2021). To address the aforementioned concerns, as well as any legal concerns regarding the need for additional malpractice insurance, partnered surgeons were designated as “volunteer faculty,” working directly under the supervision of a CTC staff surgeon.…”

Smooth transitions in critical care

“…In this issue of JETS, Savel et al describe the challenges that face the Intensive Care Unit (ICU) in an academic medical center pursuing a Level I trauma designation. [ 1 ] Numerous anecdotes of the experience are detailed within their manuscript. They have chosen to focus on the following major areas: leadership and strategy issues; intensivist staffing changes; integration and training of advanced practice practitioners; bed allocation and throughput preparation and challenges; educational issues, specifically as they relate to resident training; required training for nurses; and changes that may occur to the overall structure of the critical care service.…”