RT Book, Section A1 Seymour, Christopher W. A1 Kahn, Jeremy M. A2 Oropello, John M. A2 Pastores, Stephen M. A2 Kvetan, Vladimir SR Print(0) ID 1136412699 T1 Regionalization T2 Critical Care YR 1 FD 1 PB McGraw-Hill Education PP New York, NY SN 9780071820813 LK accessmedicine.mhmedical.com/content.aspx?aid=1136412699 RD 2024/10/09 AB KEY POINTSRegionalization refers to the systematic transfer of high-risk critically ill patients to regional referral centers where intensivists provide high-intensity care.Regionalization has several unrealized benefits including the potential to increase survival for critically ill patients through greater use of evidence-based practices and clinical experience with performing of advanced interventions, and shorter time to definitive therapy. Concentrating high-risk, high-cost care for the critically ill also has the potential to reduce overall costs for the health system.Potential unintended consequences include the downscaling of critical care capacity at smaller hospitals resulting in reduced ability to provide advanced care in emergencies due to an erosion of clinical skills, inadequate equipment, or familiarity of clinicians with best practice.Regionalization may increase intensive care unit (ICU) occupancy or census beyond the capabilities of high-volume referral centers and may also strain the capacity for interhospital transport.Barriers to implementation of regionalization include the lack of a strong centralized authority to regulate and enforce the regionalized system; strain on families due to the longer distances to travel for care at referral hospitals, lack of familiarity with physicians/care team at new hospitals, and risks of interfacility transport to new hospital; capacity constraints at large-volume hospitals; and both hospitals' and physicians' potential unwillingness to sacrifice income when patients are transferred to other hospitals for care.Special challenges include the need to educate new clinicians in understanding when patients should or should not be treated at referral hospitals, balancing stakeholder needs, and maintaining patient centeredness.