Regionalization of critical care medicine: task force report of the American College of Critical Care Medicine.
OBJECTIVE
To review the existing literature and task force opinions on regionalization of critical care services, and to synthesize a judgement on possible costs, benefits, disadvantages, and strategies.


METHODS
Pertinent literature in the English language.


METHODS
One hundred forty-six English language papers were studied to determine possible ramifications of regionalization of critical care or other similar services.


METHODS
Information on possible influence on the care of the critically ill was sought and integrated with the opinions of task force members. Possible costs, benefits, as well as disadvantages to the patient, transferring and receiving institutions, and region as a whole were sought.


RESULTS
Regionalization of critical care services was thought to be advantageous to the patient. The larger academic institutions tend to have more resources, better subspecialty availability, and expertise in the care of the critically ill. Efficiency and safety during transport need to be in place. Disadvantages of overutilization, possible costliness to both the referring institution as well as to the receiving institution were outlined. It was agreed that pediatric critical care medicine was a separate issue.


CONCLUSIONS
Regionalization of critical care medicine probably is beneficial and the concept should be explored.
Thompson
D R
DR
Society of Critical Care Medicine, Anaheim, CA 92808-2259.
Clemmer
T P
TP
Applefeld
J J
JJ
Crippen
D W
DW
Jastremski
M S
MS
Lucas
C E
CE
Pollack
M M
MM
Wedel
S K
SK
D000328:Adult; D002648:Child; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D017598:Efficiency, Organizational; D017144:Focus Groups; D006295:Health Resources; D006300:Health Services Misuse; D006801:Humans; D017146:Models, Organizational; D010348:Patient Care Team; D010360:Patient Transfer / Q000458:organization & administration; D011787:Quality of Health Care; D012041:Regional Medical Programs / Q000458:organization & administration* / Q000592:standards; D012955:Societies, Medical; D014187:Transportation of Patients; D014481:United States