[HSF] ICU Management Systems

[Michael Firstenberg]

what happens when residents are not available (OR . home. busy. etc)
or when things get really busy?  also - not just management and
supervision but also doing the work.  we all take the calls and run in
in the middle of the night with huge problems - but who deals with a
lot of the low key stuff?

On 4/9/08, alsadd <alsadd at ksu.edu.sa> wrote:
> Even though I work at a University Hospital but we follow Ed's model.
> Surgeons look after the patients. I believe this is the way to train future
> surgeons which we do. I believe it is no good to operate and let some one
> else manage especially when we have residents who have to learn. That of
> course means calls in the middle of the night for us the staff but we got
> used to it. I am against having an intensivist when there are residents.
>
> Ahmed
>
> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Edward Bender
> Sent: Tuesday, April 08, 2008 5:57 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] ICU Management Systems
>
> 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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