The practice of critical care medicine evolved from the need to provide patients who have life-threatening illnesses or injuries with immediate and continuous medical attention. From children with respiratory failure to older persons with septic shock, nurses and physicians recognized that critically ill people could be better treated if they were placed in a separate area of the hospital, with specialized equipment and highly trained medical professionals. Changes in this approach to patient care along with advances in medical technology have led to the establishment of more than 5,000 intensive care units across the United States, providing specialized treatment to the critically ill.
The following milestones have led to the development of modern-day critical care medicine:
1854 – Florence Nightingale writes about the advantages of establishing a separate area of the hospital for patients recovering from surgery. Following this model, she and her staff of nurses were able to reduce the death rate of British soldiers in the hospitals from 42 percent to 2 percent during the Crimean War.
1899 – American nurses treat yellow fever victims in isolated "quarantine" camps. This practice continues until the 1940s when an effective vaccination is identified.
1927 – The first care center for premature infants is established at the Sarah Morris Hospital in Chicago.
During World War II – Isolated rooms in the hospital, called shock wards, are established to resuscitate and care for soldiers injured in battle or undergoing surgery.
After World War II – Nursing shortages force postoperative patients to be placed together in recovery rooms to ensure attentive care. The obvious benefits in improved patient care results in the spread of recovery rooms to nearly every hospital by 1960.
1950s – The development of mechanical ventilation leads to the organization of respiratory intensive care units (ICUs) in many European and American hospitals. General ICUs for very sick patients, including postoperative patients, are also developed. The polio epidemic and iron lung treatment require a separate facility within the hospital for care of these patients.
1958 – Approximately 25 percent of community hospitals with more than 300 beds report having an ICU. By the late 1960s, most United States hospitals have at least one ICU.
1970 – A group of 29 physicians with a major interest in the care of the critically ill meet in Los Angeles to discuss establishing an organization devoted exclusively to the advancement of multiprofessional intensive care through excellence in patient care, professional education, public education, research and advocacy and form the Society of Critical Care Medicine (SCCM).
1976 – The American Association of Critical Care Nurses (AACN) establishes a certification examination for critical care nurses.
1986 – The American Board of Medical Specialties (ABMS) approves a certification of special competence in critical care for the four primary boards: anesthesiology, internal medicine, pediatrics, and surgery.
1980 – 1990s – Multiple studies demonstrate the impact of a multiprofessional, intensivist-directed model on improving outcomes.
1990s – Widespread utilization of non-invasive patient monitoring further reduces the cost and medical/nursing complications associated with care of critically ill patients.
2001 – More than 5,000 ICUs are operational in hospitals across the United States.
2002 – SCCM expands its advocacy efforts to address issues related to disaster preparedness, workforce shortages, equitable Medicare reimbursement, appropriate medical coding, and required changes for end-of-life care in the ICU.
