by Patsy Miller

By definition, a patient in a critical care unit is extremely ill. Timely, high-quality care can significantly increase a patient’s chances for survival and increase quality of life.

Today’s greater diagnostic and therapeutic options mean that physicians, patients and their families must make a complex array of decisions.

Patients in Arlington Memorial Hospital’s critical care and intensive care units (CCU and ICU, respectively) have the advantage of being cared for by intensivists, a new specialty of physicians with training in critical care. Intensivists are board certified in their primary specialty — pulmonology, surgery or anesthesiology, for example — but also have special training in critical care. Many are board certified in that subspecialty as well.

Intensivists at AMH coordinate patient care in both the ICU and CCU, a total of 39 beds. On average, a critical care doctor is responsible for 16 to 18 patients.

“Typically, ICU patients suffer from complex medical problems, often crossing many specialties. It’s not uncommon for one patient to have several consulting physicians,” says Mitchell Kuppinger, M.D., a pulmonologist with Texas Pulmonary and Critical Care Consultants and an intensivist. “It’s frequently a balancing act. Therapies for one ailment might seriously compromise another. A medicine or procedure might adversely affect another organ system.”

An intensivist is devoted to the ICU full time and specializes in total patient care. He or she understands the effects of treatments on each organ system. It’s normal to have several doctors working on one patient’s treatment, so it’s valuable to have the critical care specialist coordinating continuous and consistent care and available to take care of a problem in a timely manner. A critical asset of the intensivist is the ability to identify patients at risk and intervene early enough to prevent complications or the development of clinical problems that would prolong ICU care.

“We see our role as coordinators and advisers,” Dr. Kuppinger explains. “Here at Arlington Memorial Hospital, the attending doctors have emotional and intellectual investments in their patients and want to be involved.”

“Doctors seem to appreciate a second pair of hands by the bedside,” adds Jack Gilbey, M.D., who is also a pulmonologist/intensivist with Texas Pulmonary and Critical Care Consultants. He has been with the group since November. His pulmonary professors sparked his interest in the critical care specialty.

Hospitals with intensive-directed care have shown reduced mortality, fewer complications, shorter stays and lower costs of care.While typically only 5 to 10 percent of a hospital’s beds are ICU beds, they cost four times more than medical or surgical beds and account for 25 to 34 percent of total hospital costs.

Dr. Kuppinger offered the following example: An ICU patient needs to be weaned from a ventilator tube as early as possible.When an intensivist is with a patient full-time, the tube can be removed at that optimum time. That can help the patient recover faster and saves money.

Another common occurrence is a patient admitted to ICU in unstable condition, such as with gastrointestinal bleeding. The intensivist can step in quickly, even before the patient’s physician arrives, to begin to assess and stabilize the patient, place lines and perform other procedures. Those few seconds or minutes can greatly improve a patient’s chances for recovery and contribute to a shorter stay in ICU.

“Some conditions, such as septic shock, are very time sensitive, and having a doctor present all the time can greatly enhance the chances of recovery,” says Dr. Gilbey.

Another role of the critical care doctor is that of communicator. Kathy Glass, R.N., critical care nurse manager at AMH, notes the intensivist brings together the nurses, primary care doctors, specialists, patient and family to explain the course of care. She praises the continuity of care that patients receive at AMH because of the full-time presence of the intensivist. Families like having access to specialists who can answer their questions.

“The critical care doctor is nearby to respond to problems; we don’t have to wait on the attending doctor. And they understand the patient’s needs. They are a good asset to the hospital,” Glass adds.

“The comments we have heard have all been positive. The families have told me that having these critical care specialists shows we really care about our patients,” says Dr. Kuppinger.