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Intensive Care Medicine

Intensive Care Medicine

With methodic persistence, hospitals and medical researchers explore ways in which patient care can be improved. One area that has been studied rather extensively is the intensive care unit or ICU. Patients in the ICU have the most complex medical and surgical problems in the hospital, and these patients are at the highest risk for complications.

At any given time, the ICU patient census will include people who have suffered heart attacks or respiratory failure; people recovering from traumatic injuries, neurosurgery, or other complex surgical procedures; and people with life-threatening cases of pneumonia or other serious illness. ICU patients often require ventilator assistance to support their breathing. They are on heart monitors and they may be taking intravenous medication, fluid, and nutrition. As a result, patients in the intensive care unit require a team of multidisciplinary physician specialists, registered nurses with expertise in critical care, and other health-care specialists to address the many different aspects of their care.

Data from a number of studies have determined that patient outcomes are likely to be better in intensive care units that are managed by intensivists. Intensivists are internal medicine specialists, anesthesiologists, or surgeons who have also chosen to subspecialize in critical care medicine. They practice medicine only in the hospital critical-care setting, directly managing or coordinating the care of critically ill and injured patients in the ICU. This is a model of intensive care that is widely practiced in Europe and other countries where physicians typically specialize in either inpatient or outpatient care.

A growing number of the nation's hospitals already have board-certified intensivists directing care in their intensive care units, and Cayuga Medical Center is part of this group.

The role of the hospital intensivist is to manage the team of caregivers and to be on site in the ICU. Being located in the unit allows the intensivist to monitor medication and ventilation support closely, making adjustments on a frequent basis with better results for the patients.

Intensivists are very accessible to families. When a patient enters the ICU, this physician can bring together the patient's case manager, clergy, and other members of the support team to share information with the family or the patient's designated health-care proxy. In addition to family meetings, the intensivist meets regularly with the multidisciplinary care team including nurses, respiratory therapists, pharmacists, and nutritionists to evaluate the entire ICU census. At these meetings, the care plans for each patient are discussed from the perspective of each team member. This model, which is followed at major medical centers, is in place at Cayuga Medical Center.

Intensivists also work as consultants for other physicians such as family practitioners, internists, and surgeons. By being in the ICU, the intensivist can make an intervention quickly if a patient takes a turn for the worse, while staying in close contact with the admitting physician. This collaboration results in the best possible care for the ICU patient at a time when his or her doctor may be seeing patients in the office or operating room.

Intensivist medicine has been a recognized specialty in this country for at least three decades and is part of the growing distinction between inpatient and outpatient medicine. As outpatient physicians become increasingly busy with their office practices, the need for hospital-based physicians has grown. The result has been the emergence of intensivists skilled in caring for the sickest patients in the hospital setting. Intensivist-staffed ICUs are now the standard of care.

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