Author Affiliations: Division of Pulmonary, Allergy, and Critical Care Medicine (Drs Wagner and Halpern), Leonard Davis Institute Center for Health Incentives and Behavioral Economics (Dr Halpern), and Centers for Bioethics (Dr Halpern) and Clinical Epidemiology and Biostatistics (Dr Halpern), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
There are several reasons to doubt that we can expand the supply of high-quality critical care to meet the expected surge in demand brought on by an aging population. First, critical care expenditures already strain nations' abilities to meet other socially desirable goals.1 Second, most critically ill patients are cared for by physicians who lack specific training in critical care medicine,2 a staffing model that has been associated with worse outcomes in most studies.3 Third, severe shortages are projected in critical care workforces.4,5 Therefore, if the capacity of critical care is relatively fixed, we must instead try to improve the efficiency of care.6
Wagner J, Halpern SD. Deferred Admission to the Intensive Care Unit: Rationing Critical Care or Expediting Care Transitions?Comment on “Intensive Care Unit Bed Availability and Outcomes for Hospitalized Patients With Sudden Clinical Deterioration”. Arch Intern Med. 2012;172(6):474-476. doi:10.1001/archinternmed.2012.114