Would A Change in Nomenclature for Intensive Care Units Promote Less Aggressive Care?
The term “intensive care unit” (ICU) was meant to refer to the intensity of the resources allocated to patient care.
The term “intensive care unit” (ICU) was originally meant to refer to the intensity of the resources allocated to patient care. Today, however, ICU refers more to the intensity of the interventions undergone by the patient.
In an opinion piece published in JAMA Internal Medicine, Brian L. Block, MD, of the division of pulmonary, allergy, and critical care in the department of medicine at the University of California, San Francisco, discusses the evolution of the term ICU, which was first coined in the mid-twentieth century, and the importance of names in setting the stage for the type of care given in a hospital setting.
In the mid-twentieth century, hospitals began to organize patients according to their degree of illness rather than their ability to pay, giving rise to the terms intensive, acute, and convalescent care. Initially, intensive care was meant to describe a higher staff to patient ratio, and it served an important purpose during the polio epidemic of the 1950s. Now, however, ICU has come to mean greater use of technology and life extension.
The Dr Brock concedes that in some cases — patients with serious acute illnesses, for example — the use of more aggressive approaches to care may be justified. But in other cases the use of aggressive and invasive interventions may be at odds with what is best for the patient.
Dr Block suggests changing the name to something along the lines of critical or serious illness unit in order to shift the focus from the intervention to the patient, which may help align expectations about treatment with the care that is recommended and provided. He further suggests that such renaming could inspire innovative staffing models, encouraging personnel with expertise in palliative care or communication skills to join the unit and address patient and family needs across the spectrum of critical illness. He argues that “decades-old nomenclature should change to reflect present-day patient and societal values.”
Block BL. Does the term Intensive Care Unit promote aggressive treatment? [published online October 22, 2018] JAMA Intern Med. doi:10.1001/jamainternmed.2018.5400