Conservatism stands in the way of progress in Intensive Care

The new version of the “Organization and methods of intensive care for adults” directive is based on a fundamentally different principle of organization of intensive care than the existing directive, writes Peter van der Voort. 

Image: © Nationale Beeldbank

The revised directive “Organization and methods of intensive care for adults” was voted down at the meeting of the Dutch Association for Intensive Care (NVIC) on July 1. The text had taken more than five years to draw up.

The changing organization of care in the Netherlands makes a revision of the current directive from 2006 necessary. Especially since it became clear that, for acute care, organizational improvements have a major impact on the outcome for critically ill patients. This is more than enough justification to continue developing this. Moreover, it seems logical to actually formulate a new directive from the patient's perspective rather than from the perspective of health care providers.

Different organization

That thought led to a new version of the directive that espoused a very different organization of intensive care than the existing directive. That version also provided for the rapidly developing e-health. The overwhelming criticism of this innovative way of thinking shows that the intensivists were not yet ready for such a third order change in the organization of their services. Even after a thorough revision of the first draft and a second revision, which at most constituted a second order change, the conservative forces continue to prevail.

The EBM theory is used as a weapon while the world around us and the political decisions about care outside the EBM dogma do advance. The result is that IC places itself outside the social context. From a social and patient perspective there is nothing wrong with intensivists attending to critically ill patients in hospital 24/7, nor is there anything wrong with the most critical patients being treated at centers which are best equipped for this. The intensivists seem to be trapped in their own mode of reasoning. Can they redeem themselves or do they need help with that?