Internal and external forces continue to impact the practice of critical care medicine. Contracting for purchase of hospital services will soon be guided by the presence or absence of specific hospital attributes, including computerized physician order entry, evidence-based hospital referral, and the staffing model for intensive care unit care. The Leapfrog group, a consortium of health care purchasers, prefers to contract with hospitals that have implemented full-time intensive care unit physician staffing. This requirement is likely to increase the demand for critical care specialists. Personnel shortages are already apparent in critical care nursing and are expected to occur with physician specialists as well. Other current issues include the demand for increasingly detailed information on intensive care unit outcomes, a focus on patient safety, and cost control.
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