Critical Care Services
A team approach to pulmonary care is nowhere more valuable than in the respiratory intensive care unit (RICU). This is where specialists overlap, where care is around the clock, and where the checklist of best practices keeps growing longer. This is also where fine-tuning just a single aspect of care may nudge a patient who had been drifting aimlessly on mechanical ventilation towards successful weaning and release from the hospital.
To manage the full complexity and risk of this environment, and to capitalize on every opportunity for patient gain, Temple employs an aggressive approach in its 28-bed RICU and also in its High-Dependency Respiratory Care Unit (HDRCU). Each unit is always staffed with a pulmonologist/critical care specialist who leads a team of nurse specialists and skilled physicians in training. These dedicated teams direct all elements of patient care 24 hours a day and 7 days a week. As needed, the team leaders draw on ancillary Temple staff including respiratory therapists, physical, occupational and speech therapists, psychiatrists and psychologists, social workers, and nutritionists.
Volume matters in ICU outcomes
Temple’s facilities for patients needing inpatient pulmonary care provide an extraordinarily large number of critical care beds and guarantee a level of access and continuity of care that is rare in the U.S. In fact, according to recent data from the Pennsylvania Health Care Cost Containment Council, Temple admits more patients with severe COPD than any other single hospital in the state and it manages more cases of respiratory failure with or without mechanical ventilation than any other hospital in Central or Eastern Pennsylvania1. The bottom line: high volumes are associated with better survival rates in ICU outcomes2 and Temple is one of the nation’s high-volume centers for pulmonary critical care.
The High-Dependency Respiratory Care Unit
The 50-bed specialty HDRCU houses the dedicated Ventilator Rehabilitation Unit (VRU) and a specialized physical therapy center. The staff in the innovative HDRCU specializes in rehabilitating and weaning patients from prolonged mechanical ventilation and the application of non-invasive positive pressure ventilation. They are adept at monitoring and caring for patients with intensive needs for highflow oxygen, contiuous respiratory therapy and specialty infusions such as continuous intravenous pulmonary vasodilators. This unit was one of only three U.S. test sites chosen by Medicare to test the value of highly specialized care for mechanically ventilated patients.
Candidates for admission to the VRU include those with chronic respiratory failure from most causes and must have a tracheostomy tube and the desire to participate in daily intensive physical therapy. Patients unable to breath independently for at least one hour will first be admitted to the medical respiratory intensive care unit.
Typical features of daily medical, nursing, and rehabilitation care in the HDRCU include: aggressive whole-body rehabilitation, occupational therapy, daily weaning attempts, speech and swallow evaluations, ambulation, ventilator teaching, and bronchodilator management. In addition to meticulous patient/family education and discharge planning, the HDRCU staff also coordinates outpatient care with home care services, social services, and also with all medical device, ambulance, and oxygen vendors.
Temple is Asking:
How can we keep patients from languishing on mechanical ventilation?
All too often, patients with severe lung ailments become chronically ventilated. Failure to wean is associated with increased complications, costs, and mortality. Recent research indicates that mechanically ventilated patients in hospitals with higher volumes have better survival rates2. What do high-volume hospitals do differently to improve patient outcomes? That’s the question that Temple researchers have now turned on themselves. Preliminary results from recent Temple research—one of the largest groups of patients receiving mechanical ventilation ever studied—show that optimized Temple medical care in combination with an aggressive whole body rehabilitation and respiratory muscle training and weaning attempts led to weaning and survival rates that were higher than those reported in other weaning centers. Temple doctors and nurses will continue to ask—both in formal studies and in everyday practice—how patient risk factors and differences in specific processes of care may alter ventilation outcomes. This constant questioning and continual learning has produced the kinds of mini-breakthroughs and insights that, when shared with team members and quickly integrated into Temple protocols, have driven the cycle of better outcomes and growing volumes now evident at Temple.
References
- Pennsylvania Health Care Cost Containment Council: 2006 Hospital Performance Report, 2007.
- Kahn JM et al. N Engl J Med 2006;355:41-50.
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