[HSF] ICU Management Systems

[Edward Bender]

At our small community hospital, the cardiac surgeons manage the patients
from admit to discharge.  Last year, with the addition of an intensivist
service, I tried using them, but there were problems with availability and
expertise, so that ended quickly.  I do liberally use other services when
indicated, such as ID for endocarditis or severe surgical site infections,
pulmonologist (not so much for ventilator management, but to aid in keeping
patients off the ventilator), endocrinologist for poorly controlled or
refractory hyperglycemia and/or DKA (which happens once or twice a year).

I have found the best adjunct to care is a well trained, caring, and
available physician assistant or nurse practitioner.  Unfortunately, in our
area, these folks are less easy to find.  Most go into primary care, since
in the USA, this is probably going to be the health care model of the future
(economically doing away with primary care physicians).

Ed Bender, MD


On 4/8/08 6:46 PM, "Michael Firstenberg" <msfirst at gmail.com> wrote:

> We are in the process of exploring options to assist in the pre/post-
> operative care of our patients.  Our current system has us taking
> full care and responsibility for all aspects of this process (pre-op
> eval/tune-ups, post-op management, line changes, vent weaning, call/
> working with consults, etc).  There are obvious pluses and minuses to
> this process.  What are the other systems which people have to work
> with and what parts of them do they like and dislike.  My concern is
> that there are always plenty of people who want to be Chiefs, but few
> who want to be Indians (American expression for many who want to
> direct and run the show - esp between 9am and 5pm, but few to
> actually do they real work - i.e. bedside care, put in orders, call
> and discuss with consults, lines, tubes, weaning, even talking with
> families and helping admit patients- and do it 24 hr a day and with
> the same vigor which we - as cardiac surgeons do - particularly in a
> world were our every move and outcome gets examined under a microscope).
> 
> In short, who does the "real" work in your ICU?
> 
> Thoughts?
> Comments?
> Since we obviously have answer all of the other pressing surgical
> questions and no one has anything else to talk about.
> 
> 
> -michael
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