Regionalization of medical critical care: what can we learn from the trauma experience?

OBJECTIVE: To review the rationale for the regionalization of adult critical care and discuss how lessons from the trauma experience may be relevant to this debate.
DESIGN: Narrative review and opinion.
RESULTS: Variation in the quality of critical care among hospitals has prompted calls for regionalization of care for critically ill patients. Because of similarities between trauma and critical care, trauma is often cited as a model for the regionalization of critical care services. In reality, there are both important similarities and differences between trauma and critical care. In addition, many lessons from the trauma experience directly apply to future efforts to regionalize critical care services. In this article, we review the analogy between the regionalization of trauma and critical care and discuss how the trauma experience both supports and limits the argument for creation of a formal regionalized system of care for the critically ill. If regionalization efforts in critical care are to proceed, the lessons of the trauma experience can inform policy decisions and provide insight into the design and implementation of an effective regionalized system.