Intensive Care Units 11/02
A GFP member is trying to find out what other member institutions are doing about managing their
intensive care units. Please respond to the following questions:
1. Do you use "medical directors" to "run" your ICU's. If so, what are their job responsibilities?
2. Are they funded by professional fees, hospital support, or other support?
3. What are their specialties?
4. Do they care for patients across specialties? (e.g. surgeon ICU director only takes care of surgery;
medicine, medicine, etc).
5. When did this program start and do you feel it has been successful in improving care?
Contact
John
Ricotta
School
Stony Brook
1. We have "closed units" with selected critical care boarded physicians in
our ICUS - they are Specialty specific (i.e. Surgery, Medicine, Peds) the
only difference in CT Surgery where the Cardiac Surgeons care for their
own patients. These staff make medical decisions on the patients - in the
Surgical ICU there is more discussion with the admitting surgeon than in
the other areas - but the day to day critical care management is given
to the "ICU team” The Director has some admin responsibilities as far as Q/A
implementation of care paths etc.
2. There is some compensation - varies between specialties and is
generally not a major part of the physicians salary this has been going on for some
time 9 Years and has been helpful.
Reply
Ben
deBoisblanc
Louisiana
State U
1. Yes. Responsibilities are comprehensive: Lead interdisciplinary performance
improvement team, facilitate & expedite patient care delivered by admitting
physicians, perform peer review, represent the ICU at all hospital meetings...
2. Yes.
3. Pulmonary/CCM
4. Yes/No on a case-by-case basis.
5. 20 yrs ago, yes.
Howard
Nearman
Case Western
Reserve U
1) We do have medical directors as administrative Directors of each of our ICUs
here. They must be boarded in a primary specialty, and have received special
certification in critical care medicine. Their responsibilities include the ongoing
management of their respective unit, including policies and procedures, personnel
issues, quality assurance, etc.
2) I cannot speak for the directors of the pediatric and medical units, but there is
only token hospital support for the directors of the two surgical ICUs (less than 10%
of their income is derived from this).
3) Directors of the SICU and Cardio thoracic ICU are anesthesiologists. Pulmonary
runs the MICU, Pediatrics the PICU and cardiology the Coronary Care Unit. A
neurologist runs the Neuroscience unit.
4) As above. Anesthesiology takes care of the surgical patients - the remainder are
all specialty specific.
Charles
Mittman
U California
San Diego
5) We have had this in place for over 20 years. We strongly feel that this contributes
to better patient care. This is confirmed by a number of studies, and is also the
conclusion of the Leapfrog Group.
1. Yes, care and administration. Many services transfer PT to the medical director
others care themselves. All training, admin and quality control is the responsibility
of the medical director. The medical director can veto Rx of others so on all pts.
2. They bill as appropriate but have a medical center stipend for admin duties.
3. Internal Medicine, Critical Care, Anesthesiology.
4. ICUs are specialty specific so there is some specialization but it is not absolute.
5. Many years old, and the only way to fly.
Dr.Bolman
U of
Minnesota –
Twin Cities
Yes. They are responsible for providing care and maintaining the quality
of care in the ICU's, and for teaching the various residents and students
who rotate through the ICU's. They are funded in part by the hospital and
in part by pro fees. The Med. Dir. of the SICU is a general surgeon. The
Med. Dir. of the MICU is a Pulmonologist. They do care for patients across
specialties. For instance, lung transplant patients who turn into chronic
ICU patients are generally cared for by the MICU service. Our program has
been this way for many years, and has worked out very well.
Noel
Gibney
U of Alberta
I am the medical director for our regional critical care program in Edmonton,
Alberta, Canada and director of the academic division of critical care medicine for
the University of Alberta Medical School. I am responsible planning services at 4
general system ICUs, a burn unit and a neurosciences ICU in 4 hospitals in our
region. We have a total of 27 intensivists working in these units and about 3500
admissions annually.
1. Yes. They are responsible (jointly with the nursing manager/director) to the
hospital for the quality of care in the ICU. They are also responsible
fiscally for keeping on budget.
2. Clinical duties are funded from fee for service billing. Administrative
stipend is paid by the hospital.
3. The positions are independent of their base medical specialties and more
dependent on their administrative skills and interests.
4. Yes. All our intensivists are trained across specialties in a 2-year critical
care residency program so that we have surgeon intensivists managing patients
with severe asthma and internist intensivists managing trauma patients.
5. This program as been in place since the early 1970s and has definitely been
successful in improving care.
Stan Shane
U of Nevada
The University of Nevada program does not have a University Hospital. In Reno we
utilize the largest of the three community hospitals for our teaching programs. We
also use the VA, which has its own full time staff. The ICU there is covered by
pulmonary critical care and cardiology in rotation. There is one pulmonary group in
this community and they staff the ICU. At the community hospital(s) They definitely
take charge of the ventilators but the surgeons mange their own patients otherwise.
The medicine patients have input from many specialties. Again if the patient is
being ventilated the pulmonary critical care physician primarily manages the
patient. The lines of responsibility are sometimes confusing. Nevertheless the
patient care is very good. The funding comes from professional fees and hospital
support. I believe ventilatory care is much better under this system. I have no stats
to support this position.
Ron Clark
Med. College
of Virginia
1. No, we have medical directors for each of our ICUs (MRICU, CICU, CSICU,
NSICU, NICU, PICU, and Burn unit) and pay .1-.2 FTE of their salary for medical
direction, i.e., defining/maintaining practice standards, assisting with quality
improvement initiatives, etc.
2. Hospital pays for this medical-administrative expense.
3. Their specialties are appropriate for the unit: Medical critical care, cardiology,
cardiac surgery, neurosurgeon, neonatologist, and pediatric intensivist.
4. No
5. Has been in place for several years; yes.
Jonathon
Truwit
U of Virginia
1. Yes...they are responsible for care, patient safety, quality, protocol development
and implementation.
2 Funded by professional fees and a Medical Director allotment.
3. MICU- Pulm and CC
CCU - Cardiology
Neuro ICU - Neurology (neurointensivist with CCM certification)
Thoracic - thoracic surgeon
SICU - surgery and anesthesia
Leola
Rodgers
SUSY
Upstate
Syracuse
James
Schneider
Marshall U
PICU - pediatric critical care
Neonatal ICU - neonatologist
4. Patient board in other units, but they stay with the primary team or specialty.
5. Program was in existence before my arrival 14 years ago. Changes have been:
more collaboration with regard to boarding, protocol sharing, improvements in
standardization, significant increases in faculty with critical care certification.
1. No we do not use medical directors. We have 3 ICU physicians that rotate
responsibility for the PICU and Peds Intermediate unit. They are responsible for all
patients; however, a large percentage of our patients are open hearts managed in
conjunction with the Peds Cardiovascular Surgeon.
2. They are funded by professional fees. The hospital is in the process of providing
funding to the Dept. of Pediatrics for an additional intensivist to expand on-site
coverage hours.
3. Currently, all three are Pediatric Critical Care physicians, board certified. The
new recruitment will also be board certified in pediatric critical care.
4. Yes, they care for patients across all specialties.
5. Our program has been in place over 10 years. We feel it is extremely successful
in improving care; however, Pediatrics operates significantly different than the adult
ICU's at our facility.
At Marshall we have several faculty physicians who serve as "Medical
Director" for various hospital units (NICU, PICU, SICU, ICU, Sleep Lab,
etc.). Generally, these physicians (actually their departments) receive a
modest stipend from the hospital, usually in the $ 20,000 to $ 30,000 range
and are required to participate in a number of administrative activities
related to unit management, including utilization review, quality control,
developing practice protocols, etc. Their role as "Medical Director" does
not generally affect their normal practice patterns. They admit and care
for patients in their unit as do many other faculty physicians and community
docs.
They are usually chosen for their appropriate specialty: NICU Neonatology, PICU - Pediatric Intensivist, ICU - Pulmonology/Critical Care.
These programs have been in existence for a number of years and seem to work
well.