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Table 1 The significant increase, and expected continued increase, in mechanically ventilated patients in medical departments. Policy recommendations

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.