BY NADINE ROBINSON
The 12-bed critical care unit is gleaming as you would expect in a new hospital, but that’s not all that’s new. The patients have more privacy, the nurses are smiling and the model of care is markedly different.
A closed model, or intensivist model, was introduced in the Critical Care Unit (ICU) with the move to the new Sault Area Hospital on March 6.
Under the old open model, the doctor whose speciality most closely matched the admitted patient’s condition would serve as the lead physician. Under the intensivist model, ICU patients are looked after by board-certified intensivists who have completed a two-year fellowship providing them special training in Critical Care.
“One doctor managing their care, making diagnoses, planning tests, examining test results and talking to the families makes for better continuity of care,” said Dr. Heather O’Brien, interim medical director, Critical Care. “Intensivist training also prepares them for difficult discussions with patients and their families about end-of-life decisions, providing more compassionate care.
“Patients will see more of their physician if they are dedicated to the unit, allowing for a better care plan and a closer relationship with their doctor, preventing complications that might otherwise lead to a longer stay, reducing infections through better adherence to infection control standards and antibiotic stewardship, and improving triage of patients,” O’Brien added.
The intensivist model also liberates other specialists to focus on less seriously ill patients, improving patient coverage and resulting in less physician burnout, according to O’Brien. “A desirable workplace leads to less sick time and lower HR costs,” she said. “The model also drives consistent patterns of practice, and following best practice guidelines is always the most cost-effective.”
The intensivist model is being used successfully in Sudbury and Thunder Bay among others locations, and research from the United States has shown that reorganizing ICUs this way reduces patient mortality rates by 14 to 60 per cent.
The nurses are also happier with the change to a closed-model of care. “Nurses have rapid access to the right physician for every patient all of the time,” noted O’Brien.
“Morale is definitely better,” said Cindy Sierzputowski, who has served as an R.N. in the Critical Care unit for 25 years. “The patient environment is drastically improved and there is no confusion about who is responsible for the patients. Nurses are able to deliver better patient care and that gives us great job satisfaction.”
The nurses, including Sierzputowski, are also appreciative of the daily multidisciplinary rounds that integrate the intensivist, nurses, and other health-care professionals such as nutritionists, social workers, pharmacists and respiratory therapists into patient care. “It’s a great learning opportunity for us as nurses. There is a real team approach,” said O’Brien. “The whole team knows where we’re at and where we’re going with each patient. It’s good for patient care, and good in terms of education and guiding best practice.”
O’Brien has been busy recruiting to fill her present position, and in the New Year will turn the ICU over to Dr. Rishi Ghosh, an emergency ICU doctor and board-certified intensivist. Ghosh, who grew up in Ottawa and is currently working in Toronto, welcomes the opportunity to lead the unit, and make his home in Sault Ste. Marie.
O’Brien doesn’t think recruiting the other intensivists will be a problem. “People who want to work in a unit where they can be a major player on the team will want to come to Sault Ste. Marie. We offer a brand new hospital, a great nursing staff, and we have made it a priority to implement the closed model of care,” she said.
Once Ghosh is onboard in the New Year, O’Brien will return to her role as chief of the hospital’s Anaesthesia Department. “I’m happy to have overseen bridging the unit from the old model of care at the old hospital to a new model of care here, and will take satisfaction in knowing that the new director will lead the department in exemplary care,” she said.
Sault Area Hospital also hopes that having dedicated intensivists on staff will help facilitate their participation in the Trillium transplant program, and increase the hospital’s ability to participate in multi-centre clinical trials.
