[HSF] ICU Management Systems

Wed Apr 9 14:22:57 EDT 2008

thats kind of what i thought and how i do it but what i am trying to
figure out is how others work around limited rsources (80 hr rules no
resident   many pts all over the place problems popping up left and
right)

On 4/9/08, Prasanna Simha M <prasannasimha at gmail.com> wrote:
> The Resident does it or the Nurse does it or you yourself do it !!
> Prasanna
>
> On Wed, Apr 9, 2008 at 8:53 PM, Michael Firstenberg <msfirst at gmail.com>
> wrote:
>
> > 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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> --
> Prasanna Simha M
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