Long Stay Patients & Primary Intensivists with Dr. Jeff Edwards and Dr. Erin Gordon Part 2
Jul 3, 2023
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Dr. Jeff Edwards and Dr. Erin Gordon discuss the role of primary intensivists in the ICU, the importance of family meetings, and the benefits of primary intensivist programs. They also highlight the significance of long-stay patients in the cardiac ICU and the insights gained from families with complex medical conditions.
Primary intensivists play a crucial role in providing comprehensive care and support to long-stay patients, including those with complex needs, and forming relationships with families is seen as impactful.
Staffing primary intensivist programs depends on individual ICU capabilities and resources, with careful considerations of FTE calculations, workload distribution, and patient prioritization.
Deep dives
Role of Primary Intensivists in Long-Stay Patients
Primary intensivists play a crucial role in providing care and support to long-stay patients in intensive care units (ICUs). They encourage better communication, enhance family participation, advocate for patients and families, and attend meetings to ensure comprehensive care. Forming relationships with families, especially during end-of-life care or withdrawal of life-sustaining efforts, is seen as impactful. Primary intensivists can cater to all patients, including those with complex needs or language barriers, with eligibility criteria tailored to each ICU. The relationship and trust formed between primary intensivists and families create a unique support system.
Staffing and Decision-Making for Primary Intensivist Programs
Staffing primary intensivist programs depends on individual ICU capabilities and resources. While ideal scenarios involve every patient receiving primary nursing and primary intensivist care, limited resources necessitate prioritization. Some ICUs have predetermined criteria to decide which patients would benefit from a primary intensivist's role. Families are often given the option to choose from a list of intensivists, considering their previous interactions and trust. Limitations in staff numbers and patient load may impact the number of patients assigned to a primary intensivist, prompting a need for careful FTE (full-time equivalent) calculations and workload distribution.
Training and Future Research
Effective communication, complex care management, primary palliative care, disability bias training, and mediation principles are additional areas that could enhance the training of primary intensivists. Fellowship programs could incorporate these aspects into their curriculum, offering trainees the necessary skills to navigate difficult conversations and advocate for patients and families. Collecting and sharing data on primary intensivist interventions is crucial for building evidence-based guidelines and understanding the benefits they provide to long-stay patients and families. Future research should focus on long-term outcomes, patient experiences, and the impact of primary intensivist programs on patient care.
Jeffrey Edwards, M.D is an Associate Professor of Pediatrics at Columbia University and a pediatric intensivist at Morgan Stanley Children’s Hospital in New York. He is an active physician-investigator with clinical and research interests in children with complex chronic conditions and technology-dependence.
Erin Gordon, D.O. is an Assistant Professor of Pediatrics at University of Texas Southwestern and an intensivist in the pediatric cardiac intensive care unit. Dr. Gordon is the medical director of the inpatient developmental care program and directly involved in creating an environment that fosters the growth and development of the congenital heart disease population, including parental mental health and resilience. Her passion for patient and family advocacy has led to her desire to bring a louder voice to the concept of a “primary” intensivist.
Learning objectives:
After listening to this series of episodes, learners should be able to discuss:
The discrepant health-related outcomes of long-stay patients (LSP) and those with complex chronic conditions (CCC) in the PICU.
Barriers to delivering effective care to LSPs and those with CCC in the PICU.
Strategies to improve continuity of care to LSPs and to those with CCC in the PICU.
The rationale and evidence supporting the use of a primary intensivist program in the PICU.
Patient eligibility criteria and best practices of a primary intensivist program with an emphasis on equity and minimizing the risk of bias.
Physician specific and healthcare system related strategies to maintaining a successful primary intensivist program.
The role of a PICU fellow in providing care similar to a primary intensivist.
Next steps in implementation and research of primary intensivists in PICUs.
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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