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04 Statistik Perawatan Kritis | SCCM

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Statistik Perawatan Kritis

Panduan Statistik Perawatan Kritis memberikan statistik tentang banyak isu terkini dalam perawatan kritis di Amerika
Serikat. Hal ini dimaksudkan untuk digunakan sebagai referensi dalam upaya-upaya seperti advokasi, hubungan
masyarakat, dan pendidikan umum.

Statistik Perawatan Kritis

Society of Critical Care Medicine (SCCM) mewakili lebih dari 16.000 profesional terlatih di lebih dari
100 negara yang memberikan perawatan di unit khusus dan berupaya memberikan hasil terbaik
bagi semua pasien yang sakit kritis dan cedera. SCCM menyatakan bahwa tim perawatan
multidisiplin yang dipimpin oleh ahli intensif (dokter yang terlatih dan memiliki kredensial dalam
pengobatan perawatan kritis [CCM]) sangat penting dalam pemberian perawatan kritis,
meningkatkan kondisi bagi profesional kesehatan, dan meningkatkan kinerja keuangan rumah
sakit. Panduan ini memberikan statistik tentang banyak isu terkini dalam perawatan kritis di
Amerika Serikat. Hal ini dimaksudkan untuk digunakan sebagai referensi dalam upaya-upaya seperti
advokasi, hubungan masyarakat, dan pendidikan umum.

Biaya Perawatan Kritis

Antara tahun 2000 dan 2010, biaya CCM tahunan meningkat 92%, dari $56,6 miliar menjadi $108
miliar. Biaya tahun 2010 mewakili 13,2% biaya rumah sakit, 4,1% pengeluaran kesehatan nasional,
dan 0,72% produk domestik bruto. Biaya unit perawatan intensif (ICU) per hari pada tahun 2010
diperkirakan sebesar $4300 per hari, meningkat 61% sejak biaya per hari pada tahun 2000 sebesar
$2669.

Ketersediaan Sumber Daya Amerika Serikat untuk COVID-19

Laporan baru dari SCCM ini memperbarui statistik utama yang belum dipublikasikan sebelumnya dan menempatkan
pandemi ini dalam perspektif sejarah, serta membahas ketersediaan sumber daya utama. Laporan ini memberikan data
tentang:

Tempat tidur tersedia untuk pasien sakit kritis

Pasokan ventilator mekanis vs. perkiraan permintaan

Model penempatan staf untuk memperluas perawatan di luar ICU tradisional 

Kemungkinan Penghematan Biaya

Penghematan biaya hingga $1 miliar per tahun kehidupan yang disesuaikan dengan kualitas dapat
dicapai dengan manajemen perawatan kritis pada sepsis berat, gagal napas akut, dan intervensi
perawatan kritis umum. Penggunaan staf intensifivist 24 jam diyakini memberikan beberapa
keuntungan, termasuk penurunan biaya, mortalitas, komplikasi, lama rawat inap (LOS),
peningkatan kepuasan dokter, dan penurunan kelelahan. Namun, sebagian besar penelitian
mengenai manfaat staf intensifis 24/7 dilakukan terutama di pusat-pusat pendidikan tinggi atau
akademis yang memiliki ketajaman dan volume pasien yang tinggi. Penghematan biaya rumah sakit
tahunan hingga $13 juta dapat diwujudkan ketika perawatan diberikan oleh tim multidisiplin yang
dipimpin oleh intensifis.

Rumah sakit yang tidak memiliki petugas intensif di lokasi dapat memperoleh manfaat dari layanan
telemedis atau tele-ICU, yang merupakan sistem elektronik canggih yang menghubungkan data
pasien ICU dengan dokter intensif di lokasi terpencil. Intensivis menyediakan layanan pemantauan,
diagnostik, dan intervensi secara real-time dan bekerja dengan staf di samping tempat tidur.

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Intensivis telemedis juga berinteraksi dengan pasien dan anggota keluarganya. Di beberapa lokasi
tertentu, perawatan tele-ICU menunjukkan LOS ICU yang lebih pendek dan angka kematian di ICU
yang lebih rendah, yang dapat berarti biaya rumah sakit yang lebih rendah dan penggunaan sumber
daya yang lebih baik. Tinjauan sistematis dan meta-analisis terhadap 19 studi telemedis ICU
menyimpulkan bahwa program tele-ICU dikaitkan dengan penurunan angka kematian di ICU dan
rumah sakit serta LOS ICU tetapi tidak pada LOS rumah sakit dan memerlukan biaya yang mahal
untuk diterapkan.

Sumber:

Banerjee R, Naessens JM, Seferian EG, dkk. Implikasi ekonomi dari menghadiri liputan
intensifis di malam hari di unit perawatan intensif medis. Obat Perawatan Kritikus . 2011
Juni;39(6):1257-1262.

Chen J, Sun D, ​Yang W, dkk. Hasil klinis dan ekonomi dari program telemedis di unit perawatan
intensif: tinjauan sistematis dan meta-analisis. J Perawatan Intensif Med. Juli 2018;33(7):383-
393.

Deslich S, Coustasse A. Memperluas teknologi di ICU: kasus pemanfaatan telemedis. Telemed

Kesehatan JE. 2014 Mei;20(5):485-492.

Gruenberg DA, Shelton W, Rose SL, Rutter AE, Socaris S, McGee G. Faktor-faktor yang
mempengaruhi lama tinggal di unit perawatan intensif. Apakah J Crit Care. 2006
September;15(5):502-509.

Halpern NA, Goldman DA, Tan KS, Pastores SM. Tren penggunaan dan tempat tidur perawatan
kritis di kalangan kelompok populasi dan penerima manfaat Medicare dan Medicaid di
Amerika Serikat: 2000-2010. Obat Perawatan Kritikus. Agustus 2016;44(8):1490-1499.

Kruklitis RJ, Tracy JA, McCambridge MM. Pertimbangan klinis dan keuangan untuk
melaksanakan program telemedis ICU. Dada. Juni 2014;145(6):1392-1396.

Kumar S, Merchant S, Reynolds R. Tele-ICU: pendekatan kemanjuran dan efektivitas biaya

dalam mengelola perawatan kritis dari jarak jauh. Open Med Inform J. 2013 23 Agustus;7:24-29.

Levy MM, Rhodes A, Phillips GS, dkk. Kampanye Surviving Sepsis: hubungan antara metrik
kinerja dan hasil dalam studi 7,5 tahun. Obat Perawatan Kritikus. 2015 Januari;43(1):3-12.

Logani S, Green A, Gasperino J. Manfaat staf dokter unit perawatan intensif intensitas tinggi
berdasarkan Undang-Undang Perawatan Terjangkau. Praktek Res Perawatan Crit.
2011;2011:170814.

Masud F, Lam TYC, Fatima S. Apakah staf intensifis in-house 24/7 diperlukan di unit perawatan
intensif? Metodis Debakey Cardiovasc J. 2018 Apr-Jun;14(2):134-140.

Parikh A, Huang SA, Murthy P, dkk. Peningkatan kualitas dan penghematan biaya setelah
penerapan standar kepegawaian dokter unit perawatan intensif Leapfrog di rumah sakit
pendidikan komunitas. Obat Perawatan Kritikus. 2012 Oktober;40(10):2754-2759.

Pronovost PJ, Needham DM, Waters H, dkk. Staf dokter unit perawatan intensif: pemodelan
keuangan standar Leapfrog. Obat Perawatan Kritikus. 2006 Maret;34(3):S18-S24.

Sabov M, Daniels CE. Nilai dari staf ICU in-house 24/7 Intensivis 24/7 di ICU. Obat Perawatan
Kritikus. 2018 Januari;46(1):149-151.

Talmor D, Shapiro N, Greenberg D, Batu PW, Neumann PJ. Kapan pengobatan perawatan kritis
hemat biaya? Tinjauan sistematis literatur efektivitas biaya. Obat Perawatan Kritikus. 2006
November;34(11):2738-2747.

Trombley MJ, Hassol A, Lloyd JT, dkk. Dampak dari peningkatan pelatihan perawatan kritis dan
dukungan 24/7 (tele-ICU) terhadap pengeluaran Medicare dan pola pemanfaatan pasca
pulang. Res Pelayanan Kesehatan. Agustus 2018;53(4):2099-2117.

LB Muda, Chan PS, Lu X, Nallamothu BK, Sasson C, Cram PM. Dampak cakupan unit perawatan
intensif telemedis terhadap hasil pasien: tinjauan sistematis dan meta-analisis. Arch Magang
Med. 2011 28 Maret;171(6):498-506.

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Zimmerman JE, Kramer AA, McNair DS, Malila FM, Shaffer VL. Lama rawat di unit perawatan
intensif: pembandingan berdasarkan Evaluasi Fisiologi Akut dan Kesehatan Kronis (APACHE) IV.
Obat Perawatan Kritikus. 2006 Oktober;34(10):2517-2529.

Pasien Perawatan Kritis

Lebih dari 5 juta pasien dirawat setiap tahun di ICU AS untuk pemantauan intensif atau invasif;
dukungan jalan napas, pernapasan, atau sirkulasi; stabilisasi masalah medis akut atau yang
mengancam jiwa; penanganan cedera dan/atau penyakit secara komprehensif; dan
memaksimalkan kenyamanan bagi pasien yang sekarat. Pasien yang dirawat di ICU merupakan
populasi yang heterogen, namun semuanya mempunyai kebutuhan yang sama akan pemeriksaan
yang sering dan kebutuhan yang lebih besar akan dukungan teknologi dibandingkan pasien yang
dirawat di tempat tidur non-ICU.

Dewasa: Kondisi jantung, pernapasan, dan neurologis umum terjadi pada pasien ICU dewasa. Lima
diagnosis utama masuk ICU untuk orang dewasa adalah insufisiensi/kegagalan pernapasan dengan
dukungan ventilator, infark miokard akut, perdarahan intrakranial atau infark serebral, prosedur
kardiovaskular perkutan, dan septikemia atau sepsis berat tanpa ventilasi mekanis. Kondisi dan
prosedur lain yang melibatkan penggunaan ICU yang tinggi adalah keracunan dan efek toksik obat,
edema paru dan gagal napas, gagal jantung dan syok, aritmia jantung dan gangguan konduksi,
gagal ginjal dengan komplikasi atau komorbiditas besar, perdarahan gastrointestinal dengan
komplikasi atau komorbiditas, dan diabetes. dengan komplikasi atau penyakit penyerta. Dukungan
teknologi yang paling umum adalah ventilasi mekanis, yang dibutuhkan oleh 20%-40% pasien yang
dirawat di ICU AS.

Pediatri : Pasien yang dirawat di ICU pediatrik (PICU) mungkin menderita penyakit akut atau
eksaserbasi akut dalam konteks kondisi kronis yang kompleks. Penyakit pernapasan adalah
diagnosis yang paling umum. Median usia anak yang dirawat di PICU berkisar antara kurang dari 1
tahun hingga 1,9 tahun. Indikasi paling umum untuk masuk ke PICU meliputi penyakit pernapasan,
penyakit jantung, dan gangguan neurologis. Anak-anak dengan keterlambatan perkembangan
dapat mencapai 38% dari pasien yang dirawat di PICU. LOS lebih besar dari 7 hari pada lebih dari
35%-40% pasien yang dirawat, dan lebih dari 40% pasien yang dirawat di PICU memerlukan
ventilasi mekanis. Sepsis berat dan syok septik juga sering terjadi di PICU, dengan prevalensi lebih
dari 8% di seluruh dunia dan angka kematian lebih dari 24%.

Pasien neonatal yang dirawat di ICU neonatal (NICU) dilahirkan prematur atau cukup bulan dengan
kondisi medis atau bedah yang serius. Meskipun sebagian besar bayi baru lahir dengan berat badan
lahir sangat rendah (<1500 g) dirawat di NICU, lebih dari separuh bayi baru lahir yang dirawat di
NICU lahir cukup bulan dan dengan berat lahir normal. Hasil yang lebih baik diberikan pada bayi
baru lahir berisiko tinggi, terutama bayi prematur, yang lahir di fasilitas NICU. Tingkat kematian di
NICU berkisar antara 4% hingga 46% di negara maju dan 0,2% hingga 64,4% di negara berkembang.
American Academy of Pediatrics (AAP) mendefinisikan NICU sebagai fasilitas yang mampu
memberikan perawatan bayi baru lahir dengan dukungan hidup berkelanjutan, dukungan
pernapasan lengkap, akses terhadap spesialisasi medis dan bedah anak, ahli anestesi anak, dan
dokter mata anak.

Sumber :

Barrett ML, Smith MW, Elixhauser A, Honigman LS, Pines JM. Pemanfaatan layanan perawatan
intensif, 2011. Statistik Singkat #185. Proyek Biaya dan Pemanfaatan Layanan Kesehatan.
Badan Penelitian dan Mutu Kesehatan. November 2014. http://hcup-
us.ahrq.gov/reports/statbriefs/sb185-Hospital-Intensive-Care-Units-2011.jsp . Diakses 3 Juni
2019.

Pusat Pengendalian dan Pencegahan Penyakit (CDC). Penerimaan Unit Perawatan Intensif
Neonatal untuk Bayi dengan Berat Badan Lahir Sangat Rendah: 19 Negara Bagian, 2006. MMWR

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Morb Mortal Wkly Rep. 2010 Nov 12;59(44):1444-1447.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5944a4.htm . Diakses 3 Juni 2019.

Chow S, Chow R, Popovic M, et al. A selected review of the mortality rates of neonatal intensive
care units. Front Public Health. 2015 Oct 7;3:225.

Edwards JD, Houtrow AJ, Vasilevskis EE, et al. Chronic conditions among children admitted to
U.S. pediatric intensive care units: their prevalence and impact on risk for mortality and
prolonged length of stay. Crit Care Med. 2012 Jul;40(7):2196-2203.

Harrison W, Goodman D. Epidemiologic trends in neonatal intensive care, 2007-2012. JAMA

Pediatr. 2015 Sep;169(9):855-862.

Hassan NE, Reischman DE, Fitzgerald RK, Faustino EVS; Prophylaxis Against Thrombosis
Practice (PROTRACT) Study Investigators and the Pediatric Acute Lung Injury and Sepsis
Investigators (PALISI)/BloodNet Investigators. Hemoglobin levels across the pediatric critical
care spectrum: a point prevalence study. Pediatr Crit Care Med. 2018 May;19(5):e227-e234.

Kerklaan D, Fivez T, Mehta NM, et al. Worldwide survey of nutritional practices in PICUs. Pediatr
Crit Care Med. 2016 Jan;17(1):10-18.

Krmpotic K, Lobos AT. Clinical profile of children requiring early unplanned admission to the
PICU. Hosp Pediatr. 2013 Jul;3(3):212-218.

Pollack MM, Holubkov R, Funai T, et al; Eunice Kennedy Shriver National Institute of Child
Health and Human Development Collaborative Pediatric Critical Care Research Network.
Pediatric intensive care outcomes: development of new morbidities during pediatric critical
care. Pediatr Crit Care Med. 2014 Nov;15(9):821-827.

Traube C, Silver G, Reeder RW, et al. Delirium in critically ill children: an international point
prevalence study. Crit Care Med. 2017 Apr;45(4):584-590.

Weiss SL, Fitzgerald JC, Pappachan J, et al; Sepsis Prevalence, Outcomes, and Therapies
(SPROUT) Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)
Network. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and
therapies study. Am J Respir Crit Care Med. 2015 May 15;191(10):1147-1157.

Wunsch H, Angus DC, Harrison DA, Linde-Zwirble WT, Rowan KM. Comparison of medical
admissions to intensive care units in the United States and United Kingdom. Am J Respir Crit
Care Med. 2011 Jun 15;183(12):1666-1673.

Wunsch H, Wagner J, Herlim M, Chong DH, Kramer AA, Halpern SD. ICU occupancy and
mechanical ventilator use in the United States. Crit Care Med. 2013 Dec;41(12):2712-2719.

Intensive Care Unit Facilities

Data on U.S. ICU facilities are available from two national hospital databases: the American Hospital
Association (AHA) Hospital Statistics system and the U.S. Centers for Medicare and Medicaid Services
Healthcare Cost Report Information System (HCRIS). AHA offers data on the number of ICU beds and
units for adult (medical-surgical, cardiac, and other) and child (pediatric and neonatal) units as well
as similar data for burn units and observation, step-down, or progressive beds. AHA offers no data
on bed utilization. HCRIS offers bed and use data on adult (intensive care, coronary care,
surgical/trauma, burn, psychiatric/detoxification) and child (pediatric and neonatal) beds (but not
units). HCRIS data include U.S. government-based Medicare and Medicaid use. HCRIS has no data on
observation, step-down, or progressive beds.

AHA data: According to the AHA 2015 annual survey, the United States had 4862 acute care registered
hospitals; 2814 of these had at least 10 acute care beds and at least 1 ICU bed. These hospitals had a
total of 540,668 staffed beds and 94,837 ICU beds (14.3% ICU beds/total beds) in 5229 ICUs. There
were 46,490 medical-surgical beds in 2644 units, 14,731 cardiac beds in 976 units, 6588 other beds in
379 units, 4698 pediatric beds in 307 units, and 22,330 neonatal beds in 920 units. The median
number of beds in medical-surgical, cardiac, and other units was 12, with 10 beds in pediatrics and
18 in neonatal. Fifty-two percent of hospitals had 1 unit, 24% had 2 units, and 24% had 3 or more
units.

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HCRIS data: In 2010 there were 2977 acute care hospitals with ICU beds. In these, there were 641,395
total acute care beds with 103,900 ICU beds (16.2% ICU beds/total beds). From 2000 to 2010, the
number of critical care beds in the United States increased by 17.8%, from 88,235 to 103,900.
However, the majority of the growth in critical care bed supply is occurring in a small number of U.S.
regions that tend to have large populations, fewer baseline ICUs per 100,000 capita, higher baseline
ICU occupancy, and increased market competition. Additionally, between 2000 and 2010, the
greatest percentage increases were in neonatal beds (29%), followed by adult beds (26%); there
were minimal changes in pediatric beds (2.7%). Of the 103,900 ICU beds in 2010, 83,417 (80.3%) were
adult, 1917 (1.8%) were pediatric, and 18,567 (17.9%) were neonatal. In total, there were 33.6 beds
per 100,000 population, 35.5 beds per 100,000 adult beds (age > 18 years), 2.7 beds/100,000
pediatric beds (age 1-17 years), and 470 beds/100,000 neonatal beds (age < 1 year).

ICU days: HCRIS analysis showed that there were 150.9 million hospital days, including 25 million
ICU days in 2010 (16.5% ICU days/total days). Medicare accounted for 7.9 million ICU days (31.4%)
and Medicaid 4.3 million ICU days (17.2%).

Occupancy: Occupancy rates were calculated from HCRIS (days/possible days) data. In 2010, hospital
and ICU occupancy rates were 64.6% and 68%, respectively. Occupancy rates vary by hospital size,
with higher occupancy rates associated with larger hospitals.

Sources:

American Hospital Association. AHA Hospital Statistics. 2017 edition. Chicago, IL: American
Hospital Association; 2017.

Carr BG, Addyson DK, Kahn JM. Variation in critical care beds per capita in the United States:
implications for pandemic and disaster planning. JAMA. 2010 Apr 14;303(14):1371-1372.

Halpern NA, Goldman DA, Tan KS, Pastores SM. Trends in critical care beds and use among
population groups and Medicare and Medicaid beneficiaries in the United States: 2000-2010.
Crit Care Med. 2016 Aug;44(8):1490-1499.

Halpern NA, Pastores SM. Critical Care Medicine Beds, Use, Occupancy, and Costs in the United
States: A Methodological Review. Crit Care Med. 2015 Nov;43(11):2452-9.

Halpern NA, Pastores SM, Thaler HT, Greenstein RJ. Changes in critical care beds and
occupancy in the United States 1985-2000: Differences attributable to hospital size. Crit Care
Med. 2006 Aug;34(8):2105-12.

Odetola FO, Clark SJ, Freed GL, Bratton SL, Davis MM. A national survey of pediatric critical care
resources in the United States. Pediatrics. 2005 Apr;115(4):e382-e386.

Wallace DJ, Angus DC, Seymour CW, Barnato AE, Kahn JM. Critical care bed growth in the
United States. A comparison of regional and national trends. Am J Respir Crit Care Med. 2015
Feb;191(4):410-416.

Length of Stay
ICU LOS has been estimated at 3.8 days in the United States. However, it varies depending on patient
and ICU attributes.

Morbidity and Mortality

Despite an increasing age and severity of illness in ICU patients, there was a 35% relative decrease in
mortality for ICU admissions from 1988 to 2012. The leading causes of death in the ICU are
multiorgan failure, cardiovascular failure, and sepsis. Sepsis affects more than 1.7 million people in
the United States and is the leading cause of death in U.S. hospitals, accounting for 270,000 deaths
annually. It is also the major cause of readmissions to the hospital within 30 days, costing more than
$2 billion annually. Of patients who are diagnosed with sepsis, up to 51% develop acute renal
failure, and up to 20% have acute respiratory failure requiring mechanical ventilatory support. More
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than 75,000 children develop sepsis each year and 6800 of these children die.

Overall, mortality rates in patients admitted to adult ICUs average 10% to 29%, depending on age,
comorbidities, and illness severity. The mortality rate for patients who have been admitted to the
ICU is greater for the next 10 years after they leave the ICU compared with patients of the same age
who have never been admitted to the ICU. The overall mortality rate for pediatric ICU patients ranges
from 2% to 6%.

Sources:

Centers for Disease Control and Prevention. Trend tables. Table 19. Leading causes of death
and numbers of deaths, by sex, race, and Hispanic origin: United States, 1980 and 2016. 2017.
https://www.cdc.gov/nchs/data/hus/2017/019.pdf. Accessed June 4, 2019.

Dombrovskiy VY, Martin AA, Sunderram J, Paz HL. Rapid increase in hospitalization and
mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit
Care Med. 2007 May;35(5):1244-1250.

Hartman ME, Linde-Zwirble WT, Angus DC, Watson RS. Trends in the epidemiology of pediatric
severe sepsis. Pediatr Crit Care Med. 2013 Sep;14(7):686-93.

Levy MM, Dellinger RP, Townsend SR, et al. The Surviving Sepsis Campaign: results of an
international guideline-based performance improvement program targeting severe sepsis.
Intensive Care Med. 2010 Feb;36(2):222-231.

Randolph AG, McCulloh RJ. Pediatric sepsis: important considerations for diagnosing and
managing severe infections in infants, children, and adolescents. Virulence. 2014 Jan
1;5(1):179-189.

Rhee C, Dantes R, Epstein L, et al; CDC Prevention Epicenter Program. Incidence and trends of
sepsis in US hospitals using clinical vs claims data, 2009-2014. JAMA. 2017 Oct 3;318(13):1241-
1249.

Torio CM, Moore BJ. National inpatient hospital costs: the most expensive conditions by payer,
2013. Statistical Brief #204. Healthcare Cost and Utilization Project. Agency for Healthcare
Research and Quality. May 2016. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb204-
Most-Expensive-Hospital-Conditions.pdf. Accessed June 4, 2019.

Weiss SL, Fitzgerald JC, Pappachan J, et al; Sepsis Prevalence, Outcomes, and Therapies
(SPROUT) Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)
Network. Global epidemiology of pediatric severe sepsis: the sepsis prevalence, outcomes, and
therapies study. Am J Respir Crit Care Med. 2015 May 15;191(10):1147-1157.

Wunsch H, Guerra C, Barnato AE, Angus DC, Li G, Linde-Zwirble WT. Three-year outcomes for
Medicare beneficiaries who survive intensive care. JAMA. 2010 Mar 3;303(9):849-856.

Zimmerman JE, Kramer AA, Knaus WA. Changes in hospital mortality for United States
intensive care unit admissions from 1988 to 2012. Crit Care. 2013 Apr 27;17(2):R81.

Staffing and Salaries

The multidisciplinary ICU team may consist of critical care nurses, APPs (nurse practitioners and
physician assistants), intensivists, hospitalists, pharmacists, respiratory therapists, nutritionists,
social workers, and other professionals. Challenges exist in defining these groups and obtaining
data. For example, an intensivist can be defined as a physician formally trained in critical care, with
or without CCM board certification, and working in the ICU with variable time commitments.
However, a hospitalist, without formal CCM training, may be privileged to deliver CCM care. ICU
nurses are easily identified; however, the American Association of Critical-Care Nurses (AACN) does
not keep a global database. Similar problems exist in determining total numbers of respiratory
therapists and pharmacists and those who work primarily in the ICU. Salaries are similarly difficult
to determine because they vary greatly by experience, location, type of hospital and work model,
and of course public reporting.

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CCM nurses: According to Connie Barden, Chief Clinical Officer of the AACN, the critical care nurse
universe is approximately 512,000 (figure derived from National Council of State Boards of Nursing
2017 RN Practice Analysis, State of Nursing 2016 Whitepaper [nursing.org], and the 2015 National
Nursing Workforce Survey [J Nurs Regul. 2016;7:S1-S90]). Salaries for critical care nurses range from
$66,316 to $79,962, but these salaries vary widely depending on education, certifications, additional
skills, and number of years spent in the profession.

APPs: Estimates suggest that more than 29,700 acute care nurse practitioners and 1500 physician
assistants practice critical care in the United States. Mean salaries were estimated at $122,432 for
acute care nurse practitioners, and $122,957 for physician assistants.

Intensivists: AHA data for 2015 suggested that there were approximately 29,000 privileged
intensivists in the United States, accounting for 20,000 full-time-equivalent intensivists. American
Medical Group Association physician compensation data shows that median compensation for
intensivists in 2017 was $400,000; Medscape Intensivist Compensation Report 2018 lists this figure as
$354,000.

Respiratory therapists: The most recent (2016) data from the U.S. Bureau of Labor Statistics
estimates a national total of 130,200 respiratory therapists. Their median salary is $59,710.

ICU pharmacists: In 2012, a task force of critical care pharmacists sponsored by the American College
of Clinical Pharmacy, American Pharmacists Association, and American Society of Health-System
Pharmacists (ASHP) estimated that there were 6000-7000 practicing critical care pharmacists in the
United States with an estimated mean annual salary of $125,000. A 2011 ASHP national survey
showed that pharmacists were assigned to critical care in 68.8% of U.S. hospitals.

Sources:

American Academy of Physician Assistants. 2018 AAPA Salary Report.

https://www.aapa.org/shop/salary-report/. Accessed June 4, 2019.

American Academy of Physician Assistants. What Is a PA? Frequently Asked Questions. Updated
March 2018. https://www.aapa.org/wp-
content/uploads/2018/06/Frequently_Asked_Questions_4.3_FINAL.pdf. Accessed June 4,
2019.

American Association of Critical-Care Nurses. About Critical Care Nursing. 2015.

http://www.aacn.org/wd/publishing/content/pressroom/aboutcriticalcarenursing.pcms?
menu=. Accessed October 20, 2015.

American Association of Nurse Practitioners. NP Fact Sheet. https://www.aanp.org/about/all-

about-nps/np-fact-sheet. Accessed June 4, 2019.

Bauer SR, Kane-Gill SL. Outcome assessment of critical care pharmacist services. Hosp Pharm.
2016 Jul;51(7):507-513.

Falcione BA, Haas CE, Hess MM, et al. Sponsored by American College of Clinical Pharmacy,
American Pharmacists Association, American Society of Health-System Pharmacists. A petition
to the Board of Pharmacy Specialties requesting recognition of critical care pharmacy practice
as a specialty. November 2012.
http://www.accp.com/docs/positions/petitions/Final_CRITICAL_CARE_PETITION_For_BPS_Post.pdf.
Accessed June 4, 2019.

Halpern NA, Tan KS, DeWitt M, Pastores SM. Intensivists in U.S. acute care hospitals. Crit Care
Med. 2019 Apr;47(4):517-525.

Maclaren R, Devlin JW, Martin SJ, Dasta JF, Rudis MI, Bond CA. Critical care pharmacy services
in United States hospitals. Ann Pharmacother. 2006 Apr;40(4):612-618.

National Commission on Certification of Physician Assistants. 2017 Specialty Report.

https://prodcmsstoragesa.blob.core.windows.net/uploads/files/2017StatisticalProfilebySpecialty.pdf.
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06/09/23 08.04 Statistik Perawatan Kritis | SCCM

Accessed June 4, 2019.

Peckham C. Medscape intensivist compensation report 2015. Accessed June 4, 2019.

salary.com. Clinical pharmacist salary in the United States. Updated May 31, 2019.
http://www1.salary.com/Clinical-Pharmacist-Salary.html. Accessed June 4, 2019.

Society of Critical Care Medicine. Compensation of Critical Care Professionals. 2nd ed. Mount
Prospect, IL: Society of Critical Care Medicine; 2009.

U.S. Department of Labor, Bureau of Labor Statistics. May 2018 National Occupational
Employment and Wage Estimates United States. Last modified date: April 2, 2019.
http://www.bls.gov/oes/current/oes_nat.htm. Accessed June 4, 2019.

Workforce Shortage
Increasing ICU bed numbers over the past four decades seem to reflect an increase in the demand
for critical care services. Several factors appear to have driven the increase in demand. These
include an improved life expectancy, a larger aging population, and advances in medical
therapeutics.
Concomitantly, the Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS)
published a well-researched statistical projection study in 2000 that suggested a looming intensivist
shortage. More recent government reports have shown equivocal information. There are two
schools of thought on whether an intensivist shortage actually exists. The first suggests that ICU
beds, while increasing in number, are not always used properly. Thus, many patients admitted to
ICUs either cannot benefit from ICU care because they are too healthy or are at the end of life. Thus,
there are too many ICU beds and possibly too many intensivists. Additionally, not all ICU patients
require intensivist-level care throughout their entire ICU stay. The second school of thought suggests
that there is an ongoing and increasing intensivist shortage that is failing to keep up with the
realities of ICU admissions and the stretching of ICU professionals to deliver care throughout the
entire hospital (ie, staffing 24/7 rapid response teams), participating in 24/7 in-house ICU coverage,
providing teaching and training for all members of the ICU staff, and participating in ICU
administrative oversight and quality and safety and research activities.

A study analyzing the 2814 acute care hospitals in the United States with ICU beds in the 2015 AHA
database found that hospitals were evenly divided as to the presence of intensivists; 1469 (52%) had
intensivists and 1345 (48%) did not. Hospitals with intensivists were more likely to be located in
metropolitan areas and had nearly thrice the number of aggregate hospital beds, 3.6 times the
number of ICU beds, and almost twice as many ICUs compared with hospitals without intensivists.
However, the hospitals with intensivist coverage had approximately 75% of the ICU beds, suggesting
that the intensivist shortage may not be as problematic as perceived.

Another problem in understanding the scope of ICU coverage and the adequacy of the intensivist
workforce is that it is difficult to ascertain the scope of ICU telemedicine programs. It is possible that
hospitals without intensivists who are privileged and administering care on site may have
telemedicine contracts.

The training pipeline: Understanding the CCM fellowship training landscape is challenging. Over the
past decade (2008-2018), there has been a steady increase in the number of critical care fellows
across specialties (CCM, pulmonary-CCM, emergency medicine-CCM, surgery, anesthesiology,
pediatrics, and neonatology). There were 369 accredited adult and pediatric CCM training programs
with 2023 fellows in 2008, which has increased by 25% to 462 programs with 3074 fellows in 2018.
More than 80% of U.S. intensivists train in internal medicine CCM fellowship programs.

Sources:

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06/09/23 08.04 Statistik Perawatan Kritis | SCCM

American Thoracic Society. ICU staffing shortages linked to aging population. ATS Daily
Bulletin. 2019. http://ats-365.ascendeventmedia.com/icu-staffing-shortages-linked-to-
aging-population/. Accessed June 4, 2019.

Angus DC, Kelly MA, Schmitz RJ, White A, Popovich J Jr; Committee on Manpower for
Pulmonary and Critical Care Societies (COMPACCS). Caring for the critically ill patient. Current
and projected workforce requirements for care of the critically ill and patients with pulmonary
disease: can we meet the requirements of an aging population? JAMA. 2000 Dec 6;284(21):2762-
2770.

Association of American Medical Colleges. Workforce Studies. Accessed May 7, 2019.

Brotherton SE, Rockey PH., Etzel SI. US graduate medical education, 2004-2005: trends in
primary care specialties. JAMA. 2005 Sep 7;294(9):1075-1082.

Gooch RA, Kahn JM. ICU bed supply, utilization, and health care spending: an example of
demand elasticity. JAMA. 2014; 311(6):567-8.

Halpern NA, Pastores SM, Oropello JM. Kvetan V. Critical care medicine in the United States:
addressing the intensivist shortage and image of the specialty. Crit Care Med. 2013:41(12)2754-
61.

Halpern NA, Tan KS, DeWitt M, Pastores SM. Intensivists in U.S. acute care hospitals. Crit Care
Med. 2019 Apr;47(4):517-525.

HSM Group, Ltd. Acute care hospital survey of RN vacancy and turnover rates in 2000. J Nurs
Adm. 2002 Sep;32(9):437-439.

Joint Commission Resources. Improving Care in the ICU. Oakbrook Terrace, IL: Joint
Commission Resources; 2004.

Pastores SM, Kvetan V, Coopersmith CM et al; Academic Leaders in Critical Care Medicine
(ALCCM) Task Force of the Society of Critical Care Medicine. Workforce, workload, and burnout
among intensivists and advanced practice providers: a narrative review. Crit Care Med. 2019
Apr;47(4):550-557.

Tisherman SA, Spevetz A, Blosser SA, et al. A case for change in adult critical care training for
physicians in the United States: a white paper developed by the critical care as a specialty task
force of the Society of Critical Care Medicine. Crit Care Med. 2018 Oct;46(10):1577-1584.

U.S. Department of Health and Human Services. Health Resources and Services
Administration. Bureau of Health Workforce. National Center for Health Workforce Analysis.
The U.S. Health Workforce – State Profiles. August 2018.
https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/state-
profiles/us-workforce-state-profiles-2018.pdf Accessed June 4, 2019.

U.S. Department of Health and Human Services. Health Resources and Services
Administration. National Center for Health Workforce Analysis. Projecting the Supply of Non-
Primary Care Specialty and Subspecialty Clinicians: 2010-2025. July 2014.
https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-
research/clinicalspecialties.pdf. Accessed September 4, 2021. 

Terima kasih kepada Neil A. Halpern, MD, MCCM, yang telah berkontribusi dan memperbarui
informasi ini. Dr Halpern adalah anggota dewan editorial Pengobatan Perawatan Kritis . Dr. Halpern
adalah Direktur Pusat Perawatan Kritis dan Kepala, Layanan Pengobatan Perawatan Kritis,
Departemen Anestesiologi dan Kedokteran Perawatan Kritis di Pusat Kanker Memorial Sloan
Kettering di New York.

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