PRACTICE OF CRITICAL CARE MEDICINE IN POLAND Andrzej Kübler MD, PhD Professor and Chairman Department of Anesthesiology and Critical Care Medicine University of Wrocław School of Medicine Wrocław, Poland Andrzej Kübler MD, PhD Professor and Chairman Department of Anesthesiology and Critical Care Medicine University of Wrocław School of Medicine Wrocław, Poland

Basic hospital structure of critical care service in Poland is GENERAL INTENSIVE CARE DEPARTMENT (Medical/Surgical) This department is designated for interdisciplinary treatment of pa- tients with organ failure requiring invasive monitoring and technolo- gical support. Basic hospital structure of critical care service in Poland is GENERAL INTENSIVE CARE DEPARTMENT (Medical/Surgical) This department is designated for interdisciplinary treatment of pa- tients with organ failure requiring invasive monitoring and technolo- gical support.

Organisation and function of Inten- sive Care Departments are defined by Ministry of Health instructions. This instructions are based on recommendations of Scientific Society according to the guidelines of European Society of Intensive Care Medicine (ESICM)

Directors and medical staff mem- bers of Intensive Care Departments are full-time physicians qualified in intensive care medicine. Therefore ICU in Poland are exclusively closed units

Intensive Care Department operate inde- pendently from other departments in the hospital. Director of Department and the medical staff members are clinical deci- sion-makers and take over medical and administrative responsibility for the care of patients admitted to the unit. They have the task of coordinating multi- disciplinary cooperation and consulta- tion of medical specialities

SPECIALIST CARE UNITS are orga- nised for therapy of organ failure in specified spectrum of pathology like: cardiothoracic, nerosurgical, trauma, burn, neonatal. The number of this units is about 10% of GENERAL ICU

Other units with augmented care level like: postanesthesia, post- operative, coronary care, dialysis and other are considered to be intermediate care units and their personal, organisation and function are not so strictly defined and supervised as in general ICU

Specialist training in intensive care medicine lasts 2 years of full-time practical training in officially accre- dited Intensive Care Departments with final examination

The training program contains detailed catalogue of theoretical and practical knowledge and skills in intensive care in accordance with the recommendations of European Society of Intensive Care Medicine and European Union of Medical Specialist (UEMS)

In Poland intensive care medicine training was traditionally integra- ted in the curriculum of anes- thesiology forming the speciality: “anesthesiology and intensive care medicine”. Therefore, directors of ICU have in general background training in anesthesia

Actually, formal training in inten- sive care medicine is open to other specialities in order to transform intensive care from subspeciality in anesthesiology into supraspeciality with the multidisciplinary access to training program

Residents in surgery, internal me- dicine and some other disciplines have 1-2 month training modules in intensive care during base speciality training. The program of this training is not unified and without examination

Medical students have hours of exposure to intensive care predominantly during anesthetic teaching. There are no uniform national standards and guidelines for undergraduate teaching in intensive care medicine

Major educational need for specialist intensivist in Poland is introducing the program of continuing medical education in intensive care medicine

In the recent short survey physician working full-time in intensive care units defined following, mainly non-clinical, topics as particularly desirable to meet their educational needs:  Economics of intensive care medicine  Quality management in intensive care  Informatics and record keeping in ICU  Ethical implications for intensivists  Biostatistics and research in intensive care In the recent short survey physician working full-time in intensive care units defined following, mainly non-clinical, topics as particularly desirable to meet their educational needs:  Economics of intensive care medicine  Quality management in intensive care  Informatics and record keeping in ICU  Ethical implications for intensivists  Biostatistics and research in intensive care

Major educational need for physicians in training in intensive care is comprehensive aquisition of multidisciplinary knowledge and skills involved in different aspects of critical care medicine

Education and training program for nursing staff is considered to be a main strategic educational task for the efficient development of critical care service in Poland

There are about 300 General Intensive Care Departments in Poland (12% pediatric). Total number of ICU beds is nearly 2800 (2-5% of total hospital beds). Mortality in ICUs range from 12.9% to 46.1% with an average of 28.5% Mean stay in ICU is estimated to be 8 days There are about 300 General Intensive Care Departments in Poland (12% pediatric). Total number of ICU beds is nearly 2800 (2-5% of total hospital beds). Mortality in ICUs range from 12.9% to 46.1% with an average of 28.5% Mean stay in ICU is estimated to be 8 days