Professional Documents
Culture Documents
ICU
So expensive
per patient
per time interval
We need data about the type and quality
provided in ICU
Two Questions
1. Role and practice of an intensivist
2. The best practice model in ICU
USA vs Taiwan
10
10-15
ICU directors :
internist : 63% of all ICU
Pediatric: 31%
Neonatal: 30%
Surgical: 20%
Medical: 2%
<100 beds: 9%
>500 beds: 56%
Full-time
intensivist
Consultant
intensivist
Consultant
sprcialist
Single
physician
12
9
40
36
7
14
14
19
50
55
37
34
30
20
4
10
19
47
21
21
13
17
18
13
46
33
45
52
17
3
14
14
Hospital size
small
medium
large
very large
Type of ICU
general
MICU
SICU
specialty
NP (nurse practitioner )
PA (physician assistant )
<10%
510 ICU
medical center sub special ICU not common
MICU, Vs SICU
General ICU
An Ideal ICU
Multidisciplinary& Collaborative
approach to ICU care
Medical & nursing directors :
co-responsibility for ICU management
a team approach :
doctors, nurses, R/T, pharmacist
use of standard, protocol, guideline
consistent approach to all issues
dedication to coordination and communication for
all aspects of ICU management
emphasis on practitioner certification, research,
education, ethical issues, patient advocacy
Team Dynamics
A multidisciplinary team to effectively
attain specified objective
Physician team leader & critical care nurse
manager
Intensivists
Definitions :
coordinators and leader of the multidisiplinary
approach to the care of critically ill patients
Requirements :
trained and certified
immediately and physically available to ICU
patients
no competing priority that would interfere with
prompt delivery of critical care during scheduled
interval
Jobs of Intensivits
Coordinating and providing integrated critical care
Patient triage
admission/discharge
bed allocation
discharge planning
development and enforcement of clinical &
administrative protocol
coordination and assistance in the implementation
of quality improvement activities within ICU
Open Units
Definition :
any attending physician with hospital admitting
privileges can be the physician of record and
direct ICU care. (All other physicians are
consultants)
Disadvantage :
lack of a cohesive plan
Inconsistent night coverage
Duplication of services
Closed Units
Definition:
An intensivist is the physician of record for
ICU patients. (other physicians are consultants),
All orders & procedures carried out by ICU staff
advantage:
improved efficiency
standardized protocol for care
disadvantage:
potential to lock out private physician
increase physician conflict
Transitional Units
Definition:
intensives are locally present shared co-managed
care between ICU staff and private physician
ICU staff is a final common pathway for orders
and procedures
Advantage:
reduce physician conflict, standard policies and
procedures usually present
Disadvantage:
confusion and conflict regarding final authority &
responsibilities for patient care decision
Advantages of Intensivists
A Good ICU
Well organized
trust
coordinated care
Full-time intensivist: daily round
protocol & policies (eg: how to DC elective
operation when bed not available)
bedside nurses (master degree)
no intern
A Good ICU
A team:
doctors, nurses, R/T, pharmacists
led by full time intensivists
critical care trained
available in a timely fashion (24hr/day)
no competiting clinical responsibilities
during duty
closed units, if resources allow
Discussion
For NTUH SICU:
Technician team complex treatment
SICU CNS
uncommon in USA
Communication
Team dynamics