R Adams Cowley Shock Trauma Center
R Adams Cowley Shock Trauma Center is a free-standing trauma hospital in Baltimore, Maryland and is part of the University of Maryland Medical Center. It was the first facility in the world to treat shock. Shock Trauma was founded by R Adams Cowley, considered the father of trauma medicine. While serving in the United States Army in France following World War II, Cowley observed that many severe traumatic injuries could be stabilized if the patient could be transported to a military hospital, where a surgeon was present, within one hour of the initial injury. Dr. Cowley coined the term "golden hour" to describe this crucial period of time. Dr. Cowley thus lobbied the legislature in Maryland to purchase helicopters for the transport of trauma patients to expedite their arrival to these higher-care facilities; the Maryland legislature denied his request, due to the cost of helicopters, but he was subsequently able to persuade the State of Maryland to purchase helicopters by agreeing to the premise they be shared with the Maryland State Police.
Today all major trauma centers in the United States utilize helicopters to transport trauma patients to the hospital. During the establishment of trauma centers in the early 1970s, Dr. Cowley fought with the medical community to change the prevailing policy of first responders taking all patients, including traumas, to the "nearest hospital first." According to Dr. Cowley, the major flaw to this system was that the nearest hospital was most not capable of treating severe trauma. In 1975, a young prosecutor named Dutch Ruppersberger was involved in a nearly fatal automobile accident and had his life saved in part to being transported directly to University of Maryland's Shock Trauma Center; when Mr. Ruppersberger asked Dr. Cowley what he could do to repay him for saving his life, Dr. Cowley responded, "Run for office so you can help us get the resources we need to continue saving lives.” Mr. Ruppersberger ran for numerous local and federal elective offices all the while advocating for shock trauma.
The policy of "nearest hospital first" was abandoned, emergency medical systems across the United States now follow the model first advocated by Dr. R Adams Cowley. Shock Trauma houses over 100 inpatient beds dedicated to emergency surgery, intensive care, acute surgical care; the facility boasts a dedicated resuscitation area in excess of 13 beds. The Trauma Resuscitation Unit is located on the building's second floor. Helicopters and ambulances bring injured patients directly to the TRU for emergency treatment and stabilization. Specialized trauma teams composed of trauma surgeons and emergency medicine physicians triage and treat patients as they arrive by helicopter and ambulance. Teams of consultants are available 24/7 and include orthopedic surgeons, vascular surgeons and reconstructive surgeons, anesthesiologists, others. Shock Trauma is an academic institution and emergency-medicine residents, trauma fellows, surgical residents are involved in all aspects of patient care and evaluation.
A large team of trauma physician assistants, nurse practitioners and technicians complete the trauma team personnel and stand ready to receive victims 24 hours a day, 365 days per year. The helipad at Shock Trauma can accommodate up to four medevac helicopters at one time and has direct elevator access to the resuscitation area several stories below. Adjacent to the TRU is a vast array of equipment and facilities that are available to the patient in extremis. Shock Trauma has nine dedicated operating suites, its own unique trauma post-anesthesia care unit, in addition to two dedicated multislice CT scanners, an angiography suite, digital plain film capability; the inpatient wards of the Shock Trauma center consist of specialized intensive-care units, intermediate-care units, regular surgical-floor beds. Shock Trauma can admit patients directly into the operating room. Intensive care at Shock Trauma is a multidisciplinary endeavor: the facility boasts dedicated units for victims of multi-system and neurosurgical trauma.
Shock Trauma trains physicians and medical personnel from locations overseas and throughout the United States. In addition to training residents at the University of Maryland itself, the facility hosts emergency-medicine and surgery residents from all over the United States and Canada. Shock Trauma receives over 7500 admissions per year and provides its residents with intensive training in the evaluation and management of both blunt and penetrating injury. In May 2007, Dr. Thomas M. Scalea, physician-in-chief for the R Adams Cowley Shock Trauma Center, presented a case at the University of Maryland Medical School's annual historical clinicopathological conference in Baltimore on the assassination of President Abraham Lincoln and whether the world's first center for trauma victims could have improved the outcome had Lincoln's assassination occurred today.'This could be a recoverable injury, with a reasonable expectation he would survive,' Scalea said, noting that the assassin's weapon was impotent compared to the firepower now on the streets today.
Shock Trauma's educational mission extends beyond the training of future physicians. The facility hosts members of the United States Armed Forces, in addition to providing education for local emergency-medical service providers. In 1982, a television movie was produced by Telecom Entertainment and Glen Warren Productions about Dr. R Adams Cowley, his discovery of "The Golden Hour" and his crusade to establish the first dedicated trauma center in the world; the movie starred Willia
National Health Service (England)
The National Health Service is the publicly funded national healthcare system for England and one of the four National Health Services for each constituent country of the United Kingdom. It is the largest single-payer healthcare system in the world. Funded through the government funding and overseen by the Department of Health and Social Care, NHS England provides healthcare to all legal English residents, with most services free at the point of use; some services, such as emergency treatment and treatment of infectious diseases, are free for everyone, including visitors. Free healthcare at the point of use comes from the core principles at the founding of the National Health Service by the Labour government in 1948. In practice, "free at the point of use" means that anyone legitimately and registered with the system, available to legal UK residents regardless of nationality, can access the full breadth of critical and non-critical medical care, without payment except for some specific NHS services, for example eye tests, dental care and aspects of long-term care.
These charges are lower than equivalent services provided by a private provider and many are free to vulnerable or low-income patients. The NHS provides the majority of healthcare in England, including primary care, in-patient care, long-term healthcare and dentistry; the National Health Service Act 1946 came into effect on 5 July 1948. Private health care has continued parallel to the NHS, paid for by private insurance: it is used by about 8% of the population as an add-on to NHS services; the NHS is funded from general taxation, with a small amount being contributed by National Insurance payments and from fees levied in accordance with recent changes in the Immigration Act 2014. The UK government department responsible for the NHS is the Department of Health and Social Care, headed by the Secretary of State for Health and Social Care. On 9 January 2018, the Department of Health was renamed the Department of Social Care; the Department of Health had a £110 billion budget in 2013–14, most of this being spent on the NHS.
In 2017, UK media reported that the Care Quality Commission said that the NHS is "straining at the seams" with a "precarious" future. Sources do not always make clear; the NHS was established within the differing nations of the United Kingdom through differing legislation, such there has never been a singular British healthcare system, instead there are 4 health services in the United Kingdom. In 2009, NHS England agreed to a formal NHS constitution, which sets out the legal rights and responsibilities of the NHS, its staff, users of the service, makes additional non-binding pledges regarding many key aspects of its operations; the Health and Social Care Act 2012 came into effect in April 2013, giving GP-led groups responsibility for commissioning most local NHS services. Starting in April 2013, Primary Care Trusts began to be replaced by General Practitioner -led organisations called Clinical Commissioning Groups. Under the new system, a new NHS Commissioning Board, called NHS England, oversees the NHS from the Department of Health.
The Act has become associated with the perception of increased private provision of NHS services. In reality, the provision of NHS services by private companies long precedes this legislation, but there are concerns that the new role of the healthcare regulator could lead to increased use of private sector competition, balancing care options between private companies, NHS organisations. NHS Trusts responded to the Nicholson challenge—which involved making £20 billion in savings across the service by 2015; some NHS organisations use referral management centres to help reduce inappropriate referrals, in an attempt to save the NHS money. Millions of pounds have been spent for these services, 32% of which are provided by private companies, since 2013. Of the 211 clinical commissioning groups surveyed by the British Medical Journal in 2016, 184 responded and 72 of those said they had used such schemes. Of those CCGs using these services, 14% could show savings, 12% showed no overall savings and 74% could not show whether money had been saved.
Because these services can prevent GPs from referring patients to hospitals, there are some concerns they may delay diagnosis and compromise patient safety. GPs are leaving the profession because they feel the government undervalues them, they feel the government pushes too much work onto them. GPs who do all the work needed to ensure patient safety fear that overwork compromises their own health. There were 33,302 GPs in England in October 2017, 34,495 the previous year; the Care Quality Commission found patient safety is compromised in hospitals because staff are overworked and do not have time for safety checks and procedures. Staff shortages, high staff turnover and confusion over which NHS body is responsible for patient safety contribute to lapses in safety; the CQC stated: "Staff at both leadership and frontline levels told us that they felt overwhelmed by the volume and nature of the demands placed on them. The number of alerts and amount of other information from multiple organisations, for example about different targets and initiatives, can be unmanageable."
There are 2m patient safety incidents every year and 21,500 of them are serious. Problems have included swabs being left in a patient's bod
Emergency medicine known as accident and emergency medicine, is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians care for undifferentiated patients of all ages; as first-line providers, their primary responsibility is to initiate resuscitation and stabilization and to start investigations and interventions to diagnose and treat illnesses in the acute phase. Emergency physicians practice in hospital emergency departments, pre-hospital settings via emergency medical services, intensive care units, but may work in primary care settings such as urgent care clinics. Sub-specializations of emergency medicine include disaster medicine, medical toxicology, critical care medicine, hyperbaric medicine, sports medicine, palliative care, or aerospace medicine. Different models for emergency medicine exist internationally. In countries following the Anglo-American model, emergency medicine was the domain of surgeons, general practitioners, other generalist physicians, but in recent decades it has become recognised as a speciality in its own right with its own training programmes and academic posts, the specialty is now a popular choice among medical students and newly qualified medical practitioners.
By contrast, in countries following the Franco-German model, the speciality does not exist and emergency medical care is instead provided directly by anesthesiologists, specialists in internal medicine, cardiologists or neurologists as appropriate. In developing countries, emergency medicine is still evolving and international emergency medicine programs offer hope of improving basic emergency care where resources are limited. Emergency Medicine is a medical specialty—a field of practice based on the knowledge and skills required for the prevention and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioral disorders, it further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development. The field of emergency medicine encompasses care involving the acute care of internal medical and surgical conditions.
In many modern emergency departments, emergency physicians are tasked with seeing a large number of patients, treating their illnesses and arranging for disposition—either admitting them to the hospital or releasing them after treatment as necessary. They provide episodic primary care to patients during off hours and for those who do not have primary care providers. Most patients present to emergency departments with low-acuity conditions, but a small proportion will be critically ill or injured. Therefore, the emergency physician requires a broad field of knowledge and procedural skills including surgical procedures, trauma resuscitation, advanced cardiac life support and advanced airway management, they must have some of the core skills from many medical specialities—the ability to resuscitate a patient, manage a difficult airway, suture a complex laceration, set a fractured bone or dislocated joint, treat a heart attack, manage strokes, work-up a pregnant patient with vaginal bleeding, control a patient with mania, stop a severe nosebleed, place a chest tube, conduct and interpret x-rays and ultrasounds.
This generalist approach can obviate barrier-to-care issues seen in systems without specialists in emergency medicine, where patients requiring immediate attention are instead managed from the outset by speciality doctors such as surgeons or internal physicians. However, this may lead to barriers through acute and critical care specialties disconnecting from emergency care. Emergency medicine can be distinguished from urgent care, which refers to immediate healthcare for less emergent medical issues, but there is obvious overlap and many emergency physicians work in urgent care settings. Emergency medicine includes many aspects of acute primary care, shares with family medicine the uniqueness of seeing all patients regardless of age, gender or organ system; the emergency physician workforce includes many competent physicians who trained in other specialties. Physicians specializing in emergency medicine can enter fellowships to receive credentials in subspecialties such as palliative care, critical-care medicine, medical toxicology, wilderness medicine, pediatric emergency medicine, sports medicine, disaster medicine, tactical medicine, pain medicine, pre-hospital emergency medicine, or undersea and hyperbaric medicine.
The practice of emergency medicine is quite different in rural areas where there are far fewer other specialties and healthcare resources. In these areas, family physicians with additional skills in emergency medicine staff emergency departments. Rural emergency physicians may be the only health care providers in the community, require skills that include primary care and obstetrics. Patterns vary by region. In the United States, the employment arrangement of emergency physician practices are either private, corporate, or governmental
NHS Scotland, sometimes styled NHSScotland, is the publicly funded healthcare system in Scotland. It operates 14 territorial NHS Boards across Scotland, seven special non-geographic health boards and NHS Health Scotland. At the founding of the National Health Service in the United Kingdom, three separate institutions were created in Scotland and Wales and Northern Ireland; the NHS in Scotland was accountable to the Secretary of State for Scotland rather than the Secretary of State for Health as in England and Wales. Prior to 1948, a publicly funded healthcare system, the Highlands and Islands Medical Service, had been established in Scotland in 1913, recognising the geographical and demographic challenges of delivering healthcare in that region. Following Scottish devolution in 1999, Health and social care policy and funding became devolved to the Scottish Parliament, it is administered through the Health and Social Care Directorates of the Scottish Government. The current Cabinet Secretary for Health and Sport is Jeane Freeman and the head of staff is the Director-General Health and Social Care and Chief Executive of NHS Scotland, Paul Gray.
NHS Scotland had an operating budget of £12.2 billion in 2015–16. Health and social care are devolved issues in the United Kingdom and the separate public healthcare bodies of Scotland and Wales are each referred to as "National Health Service"; the NHS in Scotland was created as an administratively separate organisation in 1948 under the ministerial oversight of the Scottish Office, before being politically devolved in 1999. This separation of powers and financing is not always apparent to the general public due to the co-ordination and co-operation where cross-border emergency care is involved. 160,000 staff work across 14 regional NHS Boards, seven Special NHS Boards and one public health body, More than 12,000 of these healthcare staff are engaged under independent contractor arrangements. Descriptions of staff numbers can be expressed as headcount and by Whole-Time Equivalent, an estimate that helps to take account of full and part-time work patterns. Scotland's healthcare workforce includes: around 67,000 nurses and health visitors over 4,900 consultants more than 4,800 general practitioners more than 500 nurse practitioners and 1,600 registered nurses working in GP surgeries.
Dentists around 4,000 pharmacists working in community pharmacy positions, with around 1,200 retail pharmacies across Scotland. Opticians allied health professionals administrators and domestic staff. Prior to the creation of NHS in Scotland in 1948, the state was involved with the provision of healthcare, though it was not universal. Half of Scotland’s landmass was covered by the Highlands and Islands Medical Service, a state-funded health system run directly from Edinburgh, set up 35 years earlier. In addition, there had been a substantial state-funded hospital building programme during the war years. Scotland had its own distinctive medical tradition, centred on its medical schools rather than private practice, a detailed plan for the future of health provision based on the Cathcart report. Following the publication of the Beveridge Report in 1942, the UK Government responded with a white paper, A National Health Service in 1944 led by the Conservative MP and Minister for Health Henry Willink.
In its introduction, the white paper laid out the Government's intention to have the new health service operate in Scotland-- "The decision to establish the new service applies, of course, to Scotland as well as to England and Wales and the present Paper is concerned with both countries. The differing circumstances of Scotland are bound to involve certain differences of method and of organisation, although not of scope or of object... Throughout the Paper references to the Minister should be construed as references to the Minister of Health in the case of England and Wales and the Secretary of State for Scotland in the case of Scotland." The UK Parliament passed the National Health Service Act 1947, which came into effect on 5 July 1948. This foundational legislation has since been superseded; this Act provided a uniform national structure for services, provided by a combination of the Highlands and Islands Medical Service, local government and private organisations which in general was only free for emergency use.
The new system was funded from central taxation and did not involve a charge at the time of use for services concerned with existing medical conditions or vaccinations carried out as a matter of general public health requirements. Current provision of healthcare is the responsibility of fourteen geographically-based local NHS boards and seven national special health boards. Proposals for the establishment of fifteen NHS boards were announced by the Scottish Executive Health Department in December 2000. Further details about the role and function of the unified NHS health boards were provided in May 2001. From 1 October 2001 each geographical health board area had a single NHS board, responsible for improving health and health services across their local area, replacing the previous decision-making structures of 43 separate boards and trusts. In April 2004, Scotland's health care system became an integrated service under the management of NHS boards. Local authority nominees were added to board membership to improve co-ordination of health and social care.
The remaining 16 Trusts were dissolved from 1 April 2004. Hospitals are now managed by the acute division of the NHS Board. Primary care services such as GPs and phar
University of Maryland, Baltimore
The University of Maryland, Baltimore, is a public university in Baltimore, Maryland. Founded in 1807, it comprises some of the oldest professional schools of dentistry, medicine, social work and nursing in the United States, it is the original campus of the University System of Maryland and has a strategic partnership with the University of Maryland, College Park. Located on 60 acres on the west side of downtown Baltimore, it is part of the University System of Maryland. Effective July 1, 2010, Jay A. Perman was appointed president of the university by William English Kirwan, chancellor of the University System of Maryland. In 2012, the University of Maryland and the flagship University of Maryland, College Park united under the MPowering the State initiative to leverage the strengths of both institutions; the University of Maryland Strategic Partnership Act of 2016 formalized the partnership as it has created more innovative medical and educational programs in Baltimore, as well as been awarded greater research grants and joint faculty appointments.
In 2018, UMB was awarded $667 million in extramural grant funding, ranked #1 in Maryland, 15th in the country, in average salary of alumni, based on College Scorecard data released by the U. S. Department of EducationUM comprises seven professional schools: School of Medicine School of Law Dental School, first in the world School of Pharmacy School of Nursing Graduate School School of Social Work The University of Maryland at Baltimore was founded in 1807 as the Maryland College of Medicine. In 1812, it was rechartered as the University of Maryland and given the authority to establish additional faculties in law and arts and sciences; the faculty of law was founded in 1816, though it operated intermittently until 1868. The faculty of arts and sciences known as the Baltimore College for undergraduates operated intermittently in the early 19th century. From 1907 to 1920, St. John's College in Annapolis functioned as the University of Maryland's faculty of arts and sciences. In 1970, the General Assembly of Maryland established a five-campus University of Maryland network comprising the University of Maryland at Baltimore,.
The University of Maryland School of Dentistry was the first dental school in the world. Founded in 1840 as the Baltimore College of Dental Surgery, it was chartered by an act of the Maryland General Assembly, its principal founders were Chapin A. Harris, it was the first school in the world to offer a science-based curriculum in dentistry. It ranks among top 10 in the nation to receive NIH research funding; the school moved to a new building in October 2006. The new building, located adjacent to the old one in Baltimore Street, offers some of the newest facilities and technologies in the world for education and patient care; the cost of construction and equipment was over $140 million USD, the highest spent by the state of Maryland on an academic building. The University of Maryland School of Law opened in 1816 as the "Maryland Law Institute" "in a spacious and commodious building on South Street, near Market street." It is the third-oldest law school in the nation. It was founded by David Hoffman, who authored a comprehensive course of legal study that had a lasting influence on other law school programs around the country and led to the development of legal ethics programs and responsibilities.
The law school moved to a new building of English Tudor Revival architecture replacing its earlier modernistic structure on the same site at the northwest corner of West Baltimore and North Paca Streets in 2002, adjacent to the site to the north of the old Westminster Presbyterian Church and old Western Burying Grounds facing West Fayette and North Greene Streets, the cemetery where the famous poet and writer Edgar Allan Poe is buried. It is the only law school in the United States with a famous author buried on its campus; the former restored church building, now known as Westminster Hall is used for campus events and lectures and is requested for wedding and other social ceremonies. The University of Maryland School of Law was ranked 48th among law schools according to the 2017 edition of U. S. News & World Report law school rankings and was ranked among the top 10 programs for health law, clinical law and environmental law; the School of Law's students' undergraduate median GPA is a 3.47 and
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention is the leading national public health institute of the United States. The CDC is a United States federal agency under the Department of Health and Human Services and is headquartered in Atlanta, Georgia, its main goal is to protect public health and safety through the control and prevention of disease and disability in the US and internationally. The CDC focuses national attention on applying disease control and prevention, it focuses its attention on infectious disease, food borne pathogens, environmental health, occupational safety and health, health promotion, injury prevention and educational activities designed to improve the health of United States citizens. In addition, the CDC researches and provides information on non-infectious diseases such as obesity and diabetes and is a founding member of the International Association of National Public Health Institutes; the Communicable Disease Center was founded July 1, 1946, as the successor to the World War II Malaria Control in War Areas program of the Office of National Defense Malaria Control Activities.
Preceding its founding, organizations with global influence in malaria control were the Malaria Commission of the League of Nations and the Rockefeller Foundation. The Rockefeller Foundation supported malaria control, sought to have the governments take over some of its efforts, collaborated with the agency; the new agency was a branch of the U. S. Public Health Service and Atlanta was chosen as the location because malaria was endemic in the Southern United States; the agency changed names before adopting the name Communicable Disease Center in 1946. Offices were located on the sixth floor of the Volunteer Building on Peachtree Street. With a budget at the time of about $1 million, 59 percent of its personnel were engaged in mosquito abatement and habitat control with the objective of control and eradication of malaria in the United States. Among its 369 employees, the main jobs at CDC were entomology and engineering. In CDC's initial years, more than six and a half million homes were sprayed with DDT.
In 1946, there were only seven medical officers on duty and an early organization chart was drawn, somewhat fancifully, in the shape of a mosquito. Under Joseph Walter Mountin, the CDC continued to advocate for public health issues and pushed to extend its responsibilities to many other communicable diseases. In 1947, the CDC made a token payment of $10 to Emory University for 15 acres of land on Clifton Road in DeKalb County, still the home of CDC headquarters today. CDC employees collected the money to make the purchase; the benefactor behind the “gift” was Robert W. Woodruff, chairman of the board of The Coca-Cola Company. Woodruff had a long-time interest in malaria control, a problem in areas where he went hunting; the same year, the PHS transferred its San Francisco based plague laboratory into the CDC as the Epidemiology Division, a new Veterinary Diseases Division was established. An Epidemic Intelligence Service was established in 1951 due to biological warfare concerns arising from the Korean War.
The mission of CDC expanded beyond its original focus on malaria to include sexually transmitted diseases when the Venereal Disease Division of the U. S. Public Health Service was transferred to the CDC in 1957. Shortly thereafter, Tuberculosis Control was transferred to the CDC from PHS, in 1963 the Immunization program was established, it became the National Communicable Disease Center effective July 1, 1967. The organization was renamed the Center for Disease Control on June 24, 1970, Centers for Disease Control effective October 14, 1980. An act of the United States Congress appended the words "and Prevention" to the name effective October 27, 1992. However, Congress directed; the CDC focus has broadened to include chronic diseases, injury control, workplace hazards, environmental health threats, terrorism preparedness. CDC combats emerging diseases and other health risks, including birth defects, West Nile virus, avian and pandemic flu, E. coli, bioterrorism, to name a few. The organization would prove to be an important factor in preventing the abuse of penicillin.
In May 1994 the CDC admitted having sent several biological warfare agents to the Iraqi government from 1984 through 1989, including Botulinum toxin, West Nile virus, Yersinia pestis and Dengue fever virus. On April 21, 2005, then–CDC Director Julie Gerberding formally announced the reorganization of CDC to "confront the challenges of 21st-century health threats"; the four Coordinating Centers—established under the G. W. Bush Administration and Gerberding—"diminished the influence of national centers under umbrella", were ordered cut under the Obama Administration in 2009. Today, the CDC's Biosafety Level 4 laboratories are among the few that exist in the world, serve as one of only two official repositories of smallpox in the world; the second smallpox store resides at the State Research Center of Virology and Biotechnology VECTOR in the Russian Federation. The CDC revealed in 2014 that it had discovered several misplaced smallpox samples and that lab workers had been infected with anthrax.
The CDC is organized into "Centers and Offices", with each organizational unit implementing the agency's activi
Intensive care medicine
Intensive care medicine, or critical care medicine, is a branch of medicine concerned with the diagnosis and management of life-threatening conditions that may require sophisticated life support and intensive monitoring. Patients requiring intensive care may require support for cardiovascular instability lethal cardiac arrhythmias, airway or respiratory compromise, acute renal failure, or the cumulative effects of multiple organ failure, more referred to now as multiple organ dysfunction syndrome, they may be admitted for intensive/invasive monitoring, such as the crucial hours after major surgery when deemed too unstable to transfer to a less intensively monitored unit. Medical studies suggest a relation between ICU volume and quality of care for mechanically ventilated patients. After adjustment for severity of illness, demographic variables, characteristics of the ICUs, higher ICU volume was associated with lower ICU and hospital mortality rates. For example, adjusted ICU mortality was 21.2% in hospitals with 87 to 150 mechanically ventilated patients annually, 14.5% in hospitals with 401 to 617 mechanically ventilated patients annually.
Hospitals with intermediate numbers of patients had outcomes between these extremes. ICU delirium and inaccurately referred to as ICU psychosis, is a syndrome common in intensive care and cardiac units where patients who are in unfamiliar, monotonous surroundings develop symptoms of delirium; this may include interpreting machine noises as human voices, seeing walls quiver, or hallucinating that someone is tapping them on the shoulder. There exists systematic reviews in which interventions of sleep promotion related outcomes in the ICU have proven impactful in the overall health of patients in the ICU. In general, it is the most expensive, technologically advanced and resource-intensive area of medical care. In the United States, estimates of the 2000 expenditure for critical care medicine ranged from US$15–55 billion. During that year, critical care medicine accounted for 0.56% of GDP, 4.2% of national health expenditure and about 13% of hospital costs. In 2011, hospital stays with ICU services accounted for just over one-quarter of all discharges but nearly one-half of aggregate total hospital charges in the United States.
The mean hospital charge was 2.5 times higher for discharges with ICU services than for those without. Intensive care takes a system-by-system approach to treatment; as such, the nine key systems are each considered on an observation-intervention-impression basis to produce a daily plan. In addition to the key systems, intensive care treatment raises other issues including psychological health, pressure points and physiotherapy, secondary infections. In alphabetical order, the nine key systems considered in the intensive care setting are: cardiovascular system, central nervous system, endocrine system, gastro-intestinal tract, integumentary system, microbiology and respiratory system. Intensive care is provided in a specialized unit of a hospital called the intensive care unit or critical care unit. Many hospitals have designated intensive care areas for certain specialities of medicine, such as the coronary intensive care unit for heart disease, medical intensive care unit, surgical intensive care unit, pediatric intensive care unit, neuroscience critical care unit, overnight intensive-recovery, shock/trauma intensive-care unit, neonatal intensive care unit, other units as dictated by the needs and available resources of each hospital.
The naming is not rigidly standardized. For a time in the early 1960s, it was not clear that specialized intensive care units were needed, so intensive care resources were brought to the room of the patient that needed the additional monitoring and resources, it became evident, that a fixed location where intensive care resources and dedicated personnel were available provided better care than ad hoc provision of intensive care services spread throughout a hospital. Common equipment in an intensive care unit includes mechanical ventilation to assist breathing through an endotracheal tube or a tracheotomy. Critical care medicine is an important medical specialty. Physicians with training in critical care medicine are referred to as intensivists. In the United States, the specialty requires additional fellowship training for physicians having completed their primary residency training in internal medicine, anesthesiology, surgery or emergency medicine. US board certification in critical care medicine is available through all five specialty boards.
Intensivists with a primary training in internal medicine sometimes pursue combined fellowship training in another subspecialty such as pulmonary medicine, infectious disease, or nephrology. The American Society of Critical Care Medicine is a well-established multiprofessional society for practitioners working in the ICU including nurses, respiratory therapists, physicians. Most medical research has demonstrated that ICU care provided by intensivists produces better outcomes and more cost-effective care; this has led the Leapfrog Group