Critical Care Unit staffing (medical)

Critical care has evolved from its early success in simple mechanical ventilation of the lungs of polio victims to the present day where patients usually have, or are at risk of developing, failure or dysfunction of one or more organ systems requiring mechanical and pharmacological support and monitoring. The unit should have dedicated consultant sessions allocated for direct patient care with additional sessions for management, teaching, and audit activities. These sessions should be divided between several critical care-trained specialists who should be supported by trainee doctors providing round-the-clock cover on a rota which provides adequate rest.

Required skills of critical care medical staff

Management

Senior medical staff, assisted by senior nursing and pharmacy colleagues, command the primary responsibility for the structural and financial management of the unit. It is through their actions that treatment of the critically ill is initiated and perpetuated; they are ultimately responsible for the activity of the unit and patient outcome.

Decision-making

In the Critical Care Unit, most decisions are made by team consensus. Clinical decisions fall under three categories: (i) decisions relating to common or routine problems for which a unit policy exists; (ii) decisions relating to uncommon problems requiring discussion with all currently involved staff, and (iii) decisions of an urgent nature taken by critical care staff without delay.

Practical skills

Expertise in the management of complex equipment, monitoring procedures and performance of invasive procedures are required.

Clinical experience

Medical staff require experience in the recognition, prevention and management of critical illness, infection control, anaesthesia, analgesia, and organ support.

Technical knowledge

The critical care specialist has an important role in the choice of equipment used in the unit. Advice should be sought from non-medical colleagues.

Pharmacological knowledge

Drug therapy regimens are clearly open to the problems of drug interactions, while pharmacokinetics are often severely altered by the effects of major organ system dysfunction, particularly involving the liver and kidneys. Adverse reactions are common.

Teaching and training

The modern critical care specialist has acquired skills that cannot be gained outside the Critical Care Unit. Therefore, it is necessary to impart this knowledge to doctors training in the specialty.