From: Mechanical ventilation in medical departments: a necessary evil, or a blessing in bad disguise?
No. | Policy consideration | Current situation | Aim |
---|---|---|---|
1 | An augmented care unit should be present in all departments of medicine. | 90% of hospitals report presence, not necessary in all departments “(https://www.ima.org.il/mainsite/ScientificCouncil.aspx)”. | All medical departments. |
2 | Residents in internal medicine should have a 3-month mandatory rotation in the ICU, preferable in their first year. | Minority, almost none in their first year. | All residents, preferably as part of their medical (rather than elective) program. |
3 | Attending (senior) physicians should receive appropriate training in mechanical ventilation, vaso-pressor support, point-of-care US and central | Probably none. | National workshops, possibly with a medical simulations course + mandatory US course. |
4 | Advance directives regarding end-of-life care, intubation and resuscitation, to be deposited in an accessible central data bank. | Very, very few. | Either by amendment of the law or as Ministry of Health directive: family physicians should be required to discuss and fill relevant forms for elderly and/or chronically ill patients. |
5 | Terminal extubation | None | For selected cases, setting an appropriate mechanism. |
6 | Co-payment by families demanding “every possible treatment” contrary to medical advice. | So far families have the prerogative to demand tremendously costly medical care – even if medical advice is otherwise. | Co-payment should be a policy consideration if families demand mechanical ventilation in spite of medical advice. |