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May 14, 2008 > Team Approach to Critical Care Makes a Difference for Patients and Families

Team Approach to Critical Care Makes a Difference for Patients and Families

In a hospital's intensive care unit (ICU), trained doctors, nurses and other experts provide specialized care for patients with life-threatening illnesses or injuries. Each year, 5 million Americans are admitted to ICUs, receiving treatment for serious conditions ranging from respiratory or heart failure to body-wide infection (sepsis) to care after surgery. As our population ages, the need for this specialized field of medicine, also called Critical Care, continues to grow.
"Many ICU patients have sustained, or are at risk of suffering the failure of one or more vital functions, systems or organs," explains Carmencita Agcaoili, M.D., a board certified Critical Care specialist at Washington Hospital. "Consequently, they require intensive care and monitoring to reverse their near fatal conditions and temporarily support them while they recover from the underlying disease or injury."
May is National Critical Care Awareness and Recognition Month - a good time to learn more about Critical Care, what Critical Care practitioners do, and how they function in the ICU setting.
On any given day in the U.S., about 6,000 hospital ICUs care for a total of 55,000 critically ill patients. A stay in this highly specialized unit can last from hours to days or even weeks.
Traditionally, care in the ICU has been managed by the patient's attending physician. Now, studies show a team approach to ICU care management results in markedly improved patient outcomes by shortening the length of stay, giving patients and families a better experience, and saving more lives.
The Society of Critical Care Medicine reports more than 160,000 lives could be saved annually if care in the ICU were delivered by an intensivist-directed multi-professional team. An intensivist is a physician who is board certified in a medical specialty, such as internal medicine, surgery, anesthesiology or pediatrics. Intensivists have also received special education, training and subspecialty certification in Critical Care.
In the multi-professional team care model, the intensivist leads an integrated group of experts made up of any of the following individuals, depending on the patient's condition: physicians; nurses; pharmacists; respiratory therapists; nutritionists; speech, physical and occupational therapists; clergy; social workers and case managers. Any medical professional who focuses on patient-centered care could be a member of the team.
Critical Care at Washington Hospital
Last January, Washington Hospital began developing an Intensivist Program for patients in its ICU. Led by Dr. Agcaoili and working actively with admitting physicians, the multidisciplinary team visits patients once or twice a day to ensure that safe, high quality Critical Care is provided from a range of medical perspectives. The hospital plans to expand the program in the future to include additional intensivists and 'round-the-clock availability.
"Although we started the team approach only two months ago, we already see progress being made," reports Dr. Agcaoili. "We look forward to the day when the program is in full swing."
A stay in the ICU is often a stressful, highly emotional time for patients, as well as for their family and friends. To help relieve stress and confusion, the intensivist-directed team communicates regularly with patients and families, helping them understand the problem and the plan of care.
"Our philosophy is to coordinate services and offer compassionate, individualized care for both patients and families," adds Dr. Agcaoili. "We find that responding to their unmet needs helps to improve the quality and outcomes."
In Washington's ICU, families also benefit from the hospital's Family Care Assistance Program, which helps patients and families understand the illnesses or conditions treated in the intensive care setting and the work of Critical Care practitioners. Additional information is available through Krames Online, an up-to-date health education resource with more than 4,000 topics available 24 hours a day.
Advance directive advised
To help people prepare for a medical crisis that could bring them to the ICU - or any other medical unit of the hospital, Washington urges all adults over age 18 to complete an advance directive. The directive is a legal document that tells medical staff what kind of care an individual would want if he or she becomes unable to make or communicate their own medical decisions. Patients receive information about advance directives when they are admitted to Washington Hospital, but the optimal time to complete the document and have it witnessed is before a medical need arises.

For more information about advance directives, visit the California Hospital Association (CHA) website at The CHA Advance Health Care Directive is available in English and Spanish. For more information about Critical Care, go online to, on the website of the Society of Critical Care Medicine.

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