Team Effort Improves Outcomes for Critically Ill Patients
Washington Hospital Recognizes Critical Care Awareness Month
More than 5 million patients are admitted each year to intensive care units (ICUs) at hospitals in the United States. According to the Society of Critical Care Medicine, patients in ICUs that are staffed by a critical care team that includes "intensivist" physicians and other specially trained staff have double the chance of survival than those in ICUs that lack a highly trained staff.
Introduced in 2008, the Intensivist Program in Washington Hospital's 28-bed Intensive Care Unit (ICU) has already bolstered the standard of care for seriously ill patients and improved patient outcomes - including a significant decrease in mortality (death) due to sepsis (a life-threatening infection), as well as improved ventilator outcomes for patient's with respiratory failure.
"Intensivists are physicians who are board-certified in critical care medicine and in a primary specialty such as internal medicine, surgery, anesthesiology or pediatrics. Some of them have another subspecialty like pulmonary medicine, emergency medicine or infectious diseases," says Dr. Carmen Agcaoili, medical director of the intensivist program at Washington Hospital.
"We currently have five, full-time intensivists and four, part-time intensivists on staff, so the ICU is always covered 24 hours a day, every day," she says. "We also have respiratory therapists dedicated to providing ICU coverage 24/7. In addition to our dedicated critical care nurses, we have pharmacy, dietary, case manager, social work, spiritual care and rehabilitation services for ICU patients, including a physical therapist with an interest in critical care on staff."
During Critical Care Awareness and Recognition Month in May, Washington Hospital will be recognizing the efforts of members of the critical care team providing care for critically ill, vulnerable patients. Dr. Agcaoili notes the ICU team has taken several steps to raise the bar of patient care.
"We conduct daily rounds with our multidisciplinary team, going over a checklist with each patient to make sure we're following best practices," she explains. "We also have palliative care rounds every Tuesday, to help identify and prepare patients and their families for dealing with chronic and terminal illnesses. We encourage patients' families to be present during rounds, because the families often can help provide details of the patients' medical histories and treatment preferences.
In addition, Dr. Agcaoili says that a Multi-Disciplinary Team has been working on improving identifying and caring for patients who develop Delirium while in the ICU. Delirium is a sudden change in how a person thinks.
"When patients become confused, they cannot pay attention or think clearly, says Dr. Agcaoili. "This condition is very common and can be upsetting to both the patient and their family. The Intensivists and staff are working together to reduce the number of patients who develop delirium."
Working with the families and loved ones of ICU patients is an important aspect of the critical care team's efforts. The Intensivist Program has established a Family/Patient-Centered Committee to address the needs of patients and families and opportunities to improve their critical care experience. Some of their efforts to improve communication between families and members of the ICU team and provide a better hospital experience include:
- A "Getting to Know Me" questionnaire that patients and their families can fill out to provide information on the patient's occupation, favorite hobbies and other interests that would cheer them up. The information helps staff members get to know patients personally and involves families in the care process.
- Scheduling "quiet time" between 3 and 4 p.m. and "sleep time" from midnight to 4 a.m. to make sure patients and their family members all get enough rest.
- Getting spiritual care advisors involved with the patient and family early.
Another effort planned for the future is an introductory brochure with information on critical care treatments as well as information that will prepare families for a patient's transition from the ICU to a regular patient room in the hospital.
"Our team is patient-centered, and we're working to improve patient and family satisfaction," says Dr. Agcaoili. "It's all part of Washington Hospital's 'Patient First' ethic."
The critical care team at Washington Hospital also works closely with patients' attending physicians. "We offer two-day classes in the fundamentals of critical care for all doctors who admit patients to the ICU," Dr. Agcaoili explains. "The classes, which also are open to nurses, respiratory therapists and pharmacists, are co-sponsored by Washington Hospital and the Society of Critical Care Medicine."