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THE INTENSIVIST MODEL - Saving Lives Every Day With Advanced Critical Care

Published: Synapse 2011, Vol. 1

No one wants to imagine what it would be like to be seriously ill enough to be admitted to an
Intensive Care Unit (ICU). But, in a life-threatening situation, we all want the reassurance of knowing that the very best and most advanced critical care services are available nearby. Every day, countless lives depend on the services and clinical teams working in the ICUs of local hospitals across the country.

IntensivistThe Chester County Hospital has dedicated itself to providing the most effective and efficient care possible for critically ill patients. The Hospital's 14-bed Intensive Care Unit houses state-of-the-art medical equipment specifically designed for the care of critically ill or injured patients. In addition to the latest technologies, the Hospital's ICU utilizes a team approach led by Intensivists - board-certified physicians who specialize in critical care medicine. These specialists evaluate and manage the care of the patients in the ICU.

Although the Intensivist-led model has fast become the "gold standard" for critical care in the United States, only a few suburban hospitals across the country currently offer this level of service. Many use a "virtual" intensivist model instead, where the specialist is consulting remotely via teleconference technology and is not at the bedside. The Chester County Hospital has four intensivists on staff - with round-the-clock onsite coverage.

Recent research shows that nationwide 30% of all hospital deaths and 40% of all ICU deaths could be avoided by increasing the number of ICUs managed by Intensivists. These crucial findings come from the Leapfrog Group, a consortium of large healthcare purchasers who came together to initiate breakthroughs in safety and the overall value of healthcare for consumers.

"Very few ICUs meet Leapfrog's intensivist standard. We do," explains Donald Emery, MD, Critical Care Medicine. "I don't know of any other community-based medical facility in the local region where critically ill patients have a board-certified intensivist at their bedside within minutes of arriving at the Hospital. We have actually been able to accomplish this at The Chester
County Hospital, and that is distinctly unusual compared to other hospitals our size."

The Hospital's ICU team also includes Critical Care Nurse Practitioners, another unusual bonus. "With Intensivists and Nurse Practitioners on the ICU team, our nurses have two different layers of medical resources," says Suzanne Henrick, RN, MPH, CCRN, Director of Critical Care. "It is collaborative care, implemented and directed by our Intensivists with Nurse Practitioners monitoring the patient's care."

In addition, this collective approach brings together representatives from all the other necessary medical disciplines across the Hospital to ensure that every need is identified and met quickly and effectively. A multidisciplinary team makes daily rounds to each patient's bedside to plan short- and long-term goals. According to Dr. Emery, this includes reviewing every aspect of care and revising treatment as needed per each patient's present condition and his or her response to treatments.

The Unit maintains a desirable nurse-to-patient ratio of one nurse caring for one or two patients. All nurses are highly trained and experienced with the latest critical care treatments, protocols and technologies. "We have a unit-based educator to keep nurses aware of all advances in the field," says Evelyn Easter, RN, BSN, CCRN, Clinical Manager. "And, our new nurses go through an intensive six-month orientation, with a seasoned nurse by their side at all times."

There have been many advances made in critical care medicine over recent years. While other general hospitals are struggling to keep up, The Chester County Hospital has made it a priority to be on top of these changes. It offers an advanced hypothermia therapy program, bedside ultrasounds to reduce the initial and frequent need for patient transport to radiology, and life-saving protocols for patients with sepsis (a severe illness in which bacteria overwhelms the bloodstream).

"The success of our program really depends upon everyone being on the same page and sharing the same vision," notes Dr. Emery. "At all levels of the Hospital, the vision has always been 'what can we do to make this a better Hospital for the citizens of this community.' Our Hospital administrators recognize the value of having a strong ICU team and provide us the tools we need."

Henrick adds, "What we are able to offer in our ICU is amazing, and far beyond what is routinely found in a community-based hospital. We have everything in place to help people experiencing the most difficult circumstances. And, we are able to save lives every day because of it."

Story by Beth Eburn
Photos by Sarah Bones

Last Updated: 8/2/2011