New Program at Texas Health Dallas Puts Critical Care Specialists in ICU|
DALLAS — Texas Health Presbyterian Hospital Dallas is the first major medical center in North Texas to implement an intensivist program that puts the care of ICU patients under the guidance of board-certified critical care physicians, who directly oversee patient care in the ICU throughout the day — without other responsibilities in the hospital.
“The traditional model is to have pulmonologists and other critical care physicians on-call,” said Dr. Gary Weinstein, chief of critical care medicine at Texas Health Dallas and a pulmonologist on the medical staff at the hospital. “But the intensivist (physicians trained in critical care medicine) might be seeing patients in their offices across the street, on the other side of campus or in the middle of a procedure with another patient. Our program now puts an intensivist at the bedside in the ICU, caring for these critically ill, unstable patients throughout the day and ready to address complications that could arise.”
The program has been started in Texas Health Dallas’ two medical intensive care units, which care for some of the hospital’s sickest patients, including those suffering respiratory arrest, cardiac arrest, heart failure or other complex medical conditions. Even though these patients might be admitted to the hospital through the Emergency Department or by a primary care physician, their care is directed by a board-certified physician trained in critical-care medicine. Critical care nurses, nurse practitioners and physician assistants — all trained in critical care medicine — help provide care in the ICU around the clock.
“Taking care of the most critically-ill patients is what these clinicians do everyday,” said Dr. Mark Feldman, chairman of internal medicine at Texas Health Dallas. “Now we have them right at the bedside of the sickest patient, where they’re most needed — applying some of the latest advances in evidence based medicine to our critically ill patients.”
The program is designed to improve outcomes and help patients recover more quickly from complex medical conditions, said Phyllis McCorstin, R.N., clinical nurse specialist for Critical Care/Cardiology Services at Texas Health Dallas. But the critical-care intensivists aren’t only in the ICU to address emergent medical problems that can arise but also to prevent complications and avoid potential problems.
“The benefits of the program may include decreasing the average length of stay in the intensive care units, decreased hospital readmissions, and increased patient satisfaction,” McCorstin said. “It’s an effective way to care for critically ill patients, and it increases the collaboration and communication between the various healthcare professionals caring for the patient.”
Many major medical centers use hospital-based internists, called hospitalists, to provide care to patients — even those in the ICU. The hospitalists then call an intensivist or other critical care specialist for a consult if a complication arises.
“Placing critical care clinicians in the unit, where, at the most, they’re only a few feet away from the patient, is an effective system that may improve patient outcomes and reduce lengths of stay,” Weinstein said.
The goal is the same as the hospitalist movement, which has gained ground in recent years as health care providers have learned that patients need regular, real-time evaluations by physicians trained for certain patient populations — without other responsibilities in the hospital or elsewhere. In the past, these patients received primary care from their family doctors, in many cases, but those doctors had responsibilities back at their private practices and weren’t always familiar with hospital-based care.
The intensivist program is a similar model applied to the ICU, with care provided by doctors trained for an acutely-ill patient population requiring intensive care. Texas Health Dallas’ program includes multidisciplinary rounding, with evaluations from critical care physicians, ICU clinical supervisors, nurse practitioners and pulmonary therapists.
“It uses a proactive approach in all aspects of care,” Weinstein said. “While overseen by an intensivist for acute medical needs, the care includes input to address a host of issues that can affect a patient’s outcome, from psychiatric care to physical rehabilitation needs. I think it’s the future of ICU-based medicine.”
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