logging in or signing up Critical Care Delivery in ICU aSGuest15809 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: Embed: Flash iPad Dynamic Copy Does not support media & animations Automatically changes to Flash or non-Flash embed WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 3948 Category: Education License: All Rights Reserved Like it (1) Dislike it (0) Added: March 30, 2009 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: araujo80 (19 month(s) ago) Nice presentation,, curently i run my ICU,, i really need this presentation ,may i have this please email : flaviobrandao2006@yahoo.com thank you verry much Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Critical Care Delivery in ICU : Critical Care Delivery in ICU Defining the clinical roles and the best practice model From: Crit Care Med 2001:29:2007 -2019 Economic Impact of ICU (1994) : Economic Impact of ICU (1994) * <10% of hospital beds * 30% of acute care hospital cost * >20% of hospital budget * 1% of GNP expended for ICU care With aging of the population ? Demand for critical care service will increase ICU : ICU So expensive per patient per time interval We need data about the type and quality provided in ICU Two Questions : Two Questions 1. Role and practice of an intensivist 2. The best practice model in ICU USA vs Taiwan : USA vs Taiwan ???????10????? 10-15???????????? 1991 Survey in USA : 1991 Survey in USA 8% of hospital beds in USA are ICU beds 10-12 beds per unit for adult ICU 21 beds per unit for neonatal ICU Occupancy rate : 84% Category of ICU MICU: 36% mixed: 22% ICU directors : internist : 63% of all ICU 1991 Survey in USA : 1991 Survey in USA ICU directors : 61% : part time 50% : unpaid 56% : not certified in critical care medicine In 1991, full time intensivists were still not common in USA ICU director authorized admission to ICU : ICU director authorized admission to ICU Pediatric: 31% Neonatal: 30% Surgical: 20% Medical: 2% <100 beds: 9% >500 beds: 56% In general, not in charge of ICU admission ICU Survey (1997) : ICU Survey (1997) ICU administrator Anesthesia : 0.6% Medicine : 36.7% Surgery : 16% Free : 29.1% Others : 17.6% ICU Model Care : ICU Model Care Full-time intensivist model : patient care is provided by an intensivist Consultant intensivist model : an intensivist consults for another physician to coordinate or assist in critical care, but dose not have primary responsibility for care Multiple consultant model: multiple specialists are involved in the patient care, (esp. R/T doctors for ventilators), but none is designated especially as the consultant intensivist Single physician model : primary physician provides all ICU care ICU Survey (1997) : ICU Survey (1997) For all ICU patients in 1997, cared by Full time intensivist : 23.1% Consultant intensivist : 13.7% Multiple consultant : 45.6% Single physician : 14.2% Others : 3.4% Full time intensivists : Full time intensivists More common in Larger hospital Managed care penetration higher MICU ICU physicians (1997)During office hours : ICU physicians (1997)During office hours Full time in ICU : 27% Elsewhere in hospital : 44% Presence off site : 24% Unknown : 5% ICU Resident (1997) : ICU Resident (1997) Full time in ICU : 53% Cover (ICU & ward) : 42% Other : 5% Slide 16: NP (nurse practitioner ) PA (physician assistant ) <10% 1991?1997 consistent patterns : 1991?1997 consistent patterns 1/3 ICU administered by medicine department 60% ICU patients are in general ICU Full time intensives treated 23% of all ICU patients, esp. in larger hospital, MICU resident: 44% , fellow: 21% of all ICU ICU coverage by non-physician: very uncommon ?????? 5–10 ?? ICU : ?????? 5–10 ?? ICU ?? medical center‚ sub special ICU not common MICU, Vs SICU ? ???? General ICU ? ???? ???????????? Full-time intensivist, closed unit ? ?????? ? Resident ???ICU care ?? Vs + NSP, not NSP alone An Ideal ICU : An Ideal ICU Multidisciplinary& Collaborative approach to ICU care : 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 : Team Dynamics A multidisciplinary team to effectively attain specified objective Physician team leader & critical care nurse manager Intensivists : 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 : 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 Administrative Duties of Intensivits : Administrative Duties of Intensivits Admission/discharge criteria Protocol development and implementation Superving and directing performance improving activities Maintain up-to-date equipment and techniques Data collection Link to other related departments Approval of unit-based budget Critical Care Practice Pattern : Critical Care Practice Pattern Open Closed transitional Open Units : 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 : 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 : 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 : Advantages of Intensivists Morbidity (ICU, 30-day, hospital) ? Cost ? Length of stay (ICU, hospital) ? Complication ? A Good ICU : 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 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 Full time Intensivists : Full time Intensivists Timely & personal intervention by an intensivist No difference from existing literature • 24hr full time • 8-12hr /day • access in a timely period Discussion : Discussion For NTUH SICU: Technician team ? complex treatment SICU CNS ? uncommon in USA Communication Team dynamics You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Critical Care Delivery in ICU aSGuest15809 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: Embed: Flash iPad Dynamic Copy Does not support media & animations Automatically changes to Flash or non-Flash embed WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 3948 Category: Education License: All Rights Reserved Like it (1) Dislike it (0) Added: March 30, 2009 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: araujo80 (19 month(s) ago) Nice presentation,, curently i run my ICU,, i really need this presentation ,may i have this please email : flaviobrandao2006@yahoo.com thank you verry much Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Critical Care Delivery in ICU : Critical Care Delivery in ICU Defining the clinical roles and the best practice model From: Crit Care Med 2001:29:2007 -2019 Economic Impact of ICU (1994) : Economic Impact of ICU (1994) * <10% of hospital beds * 30% of acute care hospital cost * >20% of hospital budget * 1% of GNP expended for ICU care With aging of the population ? Demand for critical care service will increase ICU : ICU So expensive per patient per time interval We need data about the type and quality provided in ICU Two Questions : Two Questions 1. Role and practice of an intensivist 2. The best practice model in ICU USA vs Taiwan : USA vs Taiwan ???????10????? 10-15???????????? 1991 Survey in USA : 1991 Survey in USA 8% of hospital beds in USA are ICU beds 10-12 beds per unit for adult ICU 21 beds per unit for neonatal ICU Occupancy rate : 84% Category of ICU MICU: 36% mixed: 22% ICU directors : internist : 63% of all ICU 1991 Survey in USA : 1991 Survey in USA ICU directors : 61% : part time 50% : unpaid 56% : not certified in critical care medicine In 1991, full time intensivists were still not common in USA ICU director authorized admission to ICU : ICU director authorized admission to ICU Pediatric: 31% Neonatal: 30% Surgical: 20% Medical: 2% <100 beds: 9% >500 beds: 56% In general, not in charge of ICU admission ICU Survey (1997) : ICU Survey (1997) ICU administrator Anesthesia : 0.6% Medicine : 36.7% Surgery : 16% Free : 29.1% Others : 17.6% ICU Model Care : ICU Model Care Full-time intensivist model : patient care is provided by an intensivist Consultant intensivist model : an intensivist consults for another physician to coordinate or assist in critical care, but dose not have primary responsibility for care Multiple consultant model: multiple specialists are involved in the patient care, (esp. R/T doctors for ventilators), but none is designated especially as the consultant intensivist Single physician model : primary physician provides all ICU care ICU Survey (1997) : ICU Survey (1997) For all ICU patients in 1997, cared by Full time intensivist : 23.1% Consultant intensivist : 13.7% Multiple consultant : 45.6% Single physician : 14.2% Others : 3.4% Full time intensivists : Full time intensivists More common in Larger hospital Managed care penetration higher MICU ICU physicians (1997)During office hours : ICU physicians (1997)During office hours Full time in ICU : 27% Elsewhere in hospital : 44% Presence off site : 24% Unknown : 5% ICU Resident (1997) : ICU Resident (1997) Full time in ICU : 53% Cover (ICU & ward) : 42% Other : 5% Slide 16: NP (nurse practitioner ) PA (physician assistant ) <10% 1991?1997 consistent patterns : 1991?1997 consistent patterns 1/3 ICU administered by medicine department 60% ICU patients are in general ICU Full time intensives treated 23% of all ICU patients, esp. in larger hospital, MICU resident: 44% , fellow: 21% of all ICU ICU coverage by non-physician: very uncommon ?????? 5–10 ?? ICU : ?????? 5–10 ?? ICU ?? medical center‚ sub special ICU not common MICU, Vs SICU ? ???? General ICU ? ???? ???????????? Full-time intensivist, closed unit ? ?????? ? Resident ???ICU care ?? Vs + NSP, not NSP alone An Ideal ICU : An Ideal ICU Multidisciplinary& Collaborative approach to ICU care : 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 : Team Dynamics A multidisciplinary team to effectively attain specified objective Physician team leader & critical care nurse manager Intensivists : 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 : 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 Administrative Duties of Intensivits : Administrative Duties of Intensivits Admission/discharge criteria Protocol development and implementation Superving and directing performance improving activities Maintain up-to-date equipment and techniques Data collection Link to other related departments Approval of unit-based budget Critical Care Practice Pattern : Critical Care Practice Pattern Open Closed transitional Open Units : 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 : 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 : 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 : Advantages of Intensivists Morbidity (ICU, 30-day, hospital) ? Cost ? Length of stay (ICU, hospital) ? Complication ? A Good ICU : 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 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 Full time Intensivists : Full time Intensivists Timely & personal intervention by an intensivist No difference from existing literature • 24hr full time • 8-12hr /day • access in a timely period Discussion : Discussion For NTUH SICU: Technician team ? complex treatment SICU CNS ? uncommon in USA Communication Team dynamics