Critical Care Outcomes Tied to Insurance Status, Systematic Review Finds
ScienceDaily, April 29, 2010
According to a recent finding by the American Thoracic Society's (ATS) Health Disparities Group, among the general U.S. population, people who are uninsured are about half as likely to receive critical care services as those with insurance. J. Randall Curtis, M.D., M.P.H., president of the ATS summarizes the findings, saying, “Patients in the United States who do not have health insurance and become critically ill receive fewer critical care services and may experience worse clinical outcomes.” Currently, one-third of the population under the age of 65 is uninsured for a portion of any given year, and the costs of critical care is approaching one percent of the U.S. gross domestic product.
  To view the study, An Official American Thoracic Society Systematic Review: The Association between Health Insurance Status and Access, Care Delivery, and Outcomes for Patients Who Are Critically Ill, in the May 1, 2010 edition of the American Journal of Respiratory and Critical Care Medicine, please click here.

Debating the Ethics of Rationing End-of-Life Care
PBS NewsHour (video clip and transcript), April 26, 2010
An excerpt from a recent debate on the ethics of rationing end-of-life health care after the issue gained prominence in the health care reform discussions. The question at hand: should society engage in rationing costly health care when recovery is no longer an option? Arguments both for and against rationing were presented by a doctor, a bioethicist, two attorneys and a nurse, and were moderated by the editor of Health Affairs.

Preparedness for WMD Attack Requires Critical Care
Homeland Security Today, April 13, 2010
Preparedness for the aftermath of a crippling WMD attach remains lax even in the wake of the 9/11 attacks. Studies have shown that the response capabilities for a catastrophic nuclear attack would quickly overwhelm federal, state and local resources in the region where such an attack occurred. Meanwhile, hospitals and specialty care medical facilities across the country are closing their doors in the current economic climate, meaning fewer beds and less critical care will be available in the event of a mass casualty attack requiring an inventory of enough spare bed and care capacity for the “surge” of injured from an attack.

Variation in Critical Care Beds Per Capita in the United States: Implications for Pandemic and Disaster Planning
The Journal of the American Medical Association, (research letter), Vol. 303 No. 14, April 14, 2010
“A sudden influx in unplanned intensive care unit (ICU) admissions due to a pandemic or disaster could place substantial strain on the health care system. Without coordination of resources at the state and national level, an unexpected increase in critical illness could lead to mismatched supply and demand. To better understand the implications of this problem, we evaluated US population-level critical care bed supply….[and found that] a simultaneous episode of critical illness in a small percentage of the population would exceed regional resources in a substantial number of hospital referral regions.”

What We Learned from H1N1’s First Year
The New York Times (op-ed), April 13, 2010
While the H1N1 virus that sparked a global pandemic never became as deadly as was initially feared, it nevertheless exposed some serious shortcomings in the world’s public health response. The author asserts that “public health authorities need to become clearer about the lexicon of uncertainty — what they know and don’t know about a pandemic. They also need to be transparent about how they devise their recommendations.” He then offers suggestions for how we can prepare better for future pandemics, including approaching disease control as a global community and relying more on the cooperative efforts of international health organizations.

Hospitals Ordered To Follow End-Of-Life Care Wishes
National Public Radio (interview transcript), April 16, 2010
The release of President Obama's controversial April 15th memo requiring hospitals that participate in Medicare and Medicaid to allow gay partners to visit patients also included another controversial provision regarding patients’ desires to be kept alive—or not—using artificial means. NPR’s All Things Considered reports on the impact the memo could have on patients’ wishes for end-of-life care through two separate interviews.

Making Your Wishes Known at the End of Life
The New York Times (op-ed), April 15, 2010
One doctor’s personal experience with advance directives. The author describes the burden her father-in-law lifted from the family when it became clear that he was at the end of his life. Dr. Pauline Chen echoes several recent studies, saying that advance directives do indeed make a difference in how the patient is treated, ensuring that they die in a manner consistent with their wishes when the patient becomes too incapacitated to make the necessary care decisions.

Advance care planning focus of awareness campaign
American Medical News, April 16, 2010
In honor of April 16th’s third annual National Healthcare Decisions Day, more than 850 hospitals, hospices, law firms and other organizations around the country (including the American Medical Association) participated in a campaign designed to raise awareness about the need for advance care planning and make it easier for patients to make their wishes known. According to the Agency for Healthcare Research and Quality, only a third of patients have living wills, and fewer than half of patients who have severe or terminal illnesses have advance directives—statistics that the campaign seeks to improve.

Critical caring for both patients and families: A Nurse's Journal
Clevelend.com (blog), April 24, 2010
In a column written by nurses about their working experiences, a critical care nurse at University Hospitals in Cleveland, OH describes the efforts that nurses make to ensure that patients and their families make the correct decisions in the midst of a crisis, and to facilitate communication between and amongst patients, their families, and the healthcare team. As the author states, “critical care nursing is more than meeting the physiologic and technical needs of the patient…. Nurses go beyond performing task to providing care.”

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