Advanced ICU Care® FAQ: Physicians

“It would be extremely difficult to provide 24/7 coverage for patients in a hospital ICU because you just don’t have enough physicians or intensivists across the country. The service Advanced ICU Care brings to the table allows us to provide an increased level of care that markedly improves patient safety.”
-- Dr. Larry Hegland,
chief medical officer at Saint Clare’s Hospital
Follow the links below to navigate directly to specific questions.

 

 

What impact will Advanced ICU Care's program have on private attending physicians?

The system is designed to support local physicians and their patient care.  There is no effect on their billing of professional fees.  The attending physician maintains the authority to set the daily care plan.  The role of Advanced ICU Care’s program is to facilitate and expedite the physician’s care plan while enabling him or her to conduct his or her hospital/office practice more efficiently.  At night and on weekends the eICU intensivists field calls from the ICU. Local physicians often discover that the number of calls interrupting their nights, office hours and operating room time improves dramatically.

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Who does procedures/emergency procedures if they are needed?

All hospitals have processes in place to deal with common emergency procedures. These include dedicated in-house personnel (physician assistants, critical care nurse practitioners, house physicians, hospitalists, anesthesiology personnel and emergency department physicians) or specialty physicians on call from home (cardiologist for pacemakers, etc.). These processes remain in place, except that the call for the procedure would likely be initiated by the intensivist at the eICU, after discussion with the attending physician. If surgical evaluation is required, the eICU intensivist contacts the surgeon requested by the attending physician. eICU intensivists coordinate these activities, maintaining the nurse at the bedside.

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Do the eICU physicians write notes and orders?

Yes. eICU physicians have privileges at all of the hospitals to which they are providing supplemental care and therefore are able to prescribe treatments and enter notes into the chart. Notes and orders are created from the eICU when clinically indicated and provide only relevant clinical information. They are electronically signed using a unique personal identification number (PIN) and transmitted to a printer or transferred electronically for inclusion into the chart.

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Who staffs the eICU facility?

The Advanced ICU Care eICU Operations Center is staffed by on-site, fellowship-trained, board-certified intensivist physicians, CCRN-certified critical care nurses and health care assistants. Our critical care nurses have an average of 20 years of critical care experience.

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What data are the intensivists and nurses in the eICU Operations Center able to monitor?

Powerful technology infrastructure links hospital ICUs with the eICU Operations Center through telemedicine and computer networking. Staff in the eICU® Operations Center are linked by voice, video and data to the hospital ICUs. Intensivists and nurses are able to monitor real-time vital signs through interfaces with the hospital’s monitoring equipment, visualize the patient by a high-resolution camera mounted in the patient’s room, and access the patient’s medical record, laboratory results, medications and radiographic images.

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Does Advanced ICU Care accommodate an attending physician's preference for the
extent of the eICU intensivist's involvement with his or her patients?

Yes. Attending physicians and consultants designate one of two categories of care:

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Categories of eICU® Care

Category A

The eICU physician actively carries out the attending physician’s care plan and initiates new therapies as needed. The eICU physician notifies the attending physician of major changes in patient status.

Initiate new therapies as needed (i.e., evaluation and therapy of new fever, ventilator weaning and adjustments, volume resuscitation, initiate and titrate vasoactive regimens).

ICU Best Practices

  • DVT Prophylaxis
  • Stress Ulcer Prophylaxis
  • Sepsis Management Bundle
  • Ventilator Associated Pneumonia Bundle -Increased Head of Bed -Sedation Vacation -Weaning Trials
  • B Blockers in Acute MI, when not contraindicated
  • Low Tidal Volume Ventilation for ALI
  • Glucose Control
Notify attending physician and/or appropriate consultants immediately of major changes in patient’s condition.

Category B

The eICU physician intervenes for life threatening emergencies and evidence based care, and contacts the attending physician for all other medical conditions.

Maintain therapies outlined in existing patient care plan (i.e., ventilator support, weaning plan, fluid support, vasoactive medications).

Initiate minor non-emergent therapies (i.e. potassium, magnesium replacement, maintaining O2 saturations).

ICU Best Practices

  • DVT Prophylaxis
  • Stress Ulcer Prophylaxis
  • Sepsis Management Bundle
  • Ventilator Associated Pneumonia Bundle -Increased Head of Bed -Sedation Vacation
    -Weaning Trials
  • B Blockers in Acute MI, when not contraindicated
  • Low Tidal Volume Ventilation for ALI
  • Glucose Control
Notify attending physician and/or appropriate consultants immediately of all other situations.

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