[Development of surgical intensive care medicine and status quo in Germany].

Abstract

Introduction: Intensive care medicine in Germany has fundamentally developed in the context of medical progress and changed treatment requirements. Originally preceded by pioneer work in surgery, intensive medical care facilities are nowadays decisive cost drivers in patient care. Earlier models from around the 1930s were replaced by specialization and interdisciplinary cooperation. Against this background the present study investigated the current state of care, the structures for continuing education and the implementation of surgical intensive and intermediate care (IMC) wards.

Material and methods: Between 27 February 2023 and 8 May 2023, a representative sample of 1106 intensive care wards was pooled using an anonymous online survey on a German web server (lamapoli.de) and 181 complete replies could be evaluated. The survey incorporated 42 questions, which in addition to the demographic acquisition also requested data on the resources, leadership and continuing education modalities of personnel on independent surgical intensive care wards as well as interdisciplinary surgical intensive care wards (IOI) and IMCs.

Results: Approximately 17% of the hospitals surveyed had their own surgical intensive care ward, predominantly in university hospitals. These units are characterized by a high presence of the specialist discipline and qualified personnel with additional qualifications in intensive care medicine. In contrast, interdisciplinary intensive care wards were used in facilities with a lower level of care, frequently managed by anesthesiology departments. The continuing education times for assistant surgeons were in most cases longer than 6 months, which promotes an intensive transfer of knowledge and interdisciplinary cooperation. The IMC wards are also an integral component of surgical care even though they are personnel intensive and more economically challenging. The study shows that surgical intensive care medicine has a well-structured, discipline-specific care and training, especially at university locations. In facilities with lower levels of care interdisciplinary models dominate, which also enable an adequate training. Nevertheless, the debate on the retention of discipline-specific knowledge in intensive care medicine remains a current topic in order to ensure a high quality of perioperative care.