Intensivists — Caring For The Sickest Of The Sick

Residents within Milford Regional Medical Center’s (MRMC) service area can take comfort in knowing that if they or a loved one ever find themselves in MRMC’s intensive care unit (ICU), they will receive a high level of care, which studies show is lacking in most other hospitals. Milford Regional Medical Center is one of few hospitals nationwide that offer full-time intensivists, board-certified physicians who are additionally certified in critical care medicine.

According to The Leapfrog Group for Patient Safety, an association of companies and organizations that strives to improve the quality of health care, more than 54,000 deaths that occur annually in the ICU could be avoided by increasing the number of intensivists on hand. The group estimates, however, that only 10 percent of ICUs in the United States meet Leapfrog’s intensivist standard; Milford Regional is one of them.

“The intensivist brings critical skills that other specialists don’t,” said Mary Small, nurse manager of the ICU. “They’re board-certified to take care of the ‘sickest of the sick’ patients and their families.”

In the ICU, patients with acutely life-threatening illnesses or injuries receive specialized care, such as mechanical ventilation and invasive cardiac monitoring. Ms. Small said that five registered nurses staff every shift along with certified nurses’ aides, and they work closely with the Medical Center’s intensivists.

Director of Pulmonary and Critical Care Services Frederick J. Curley, M.D., also of Lung, Allergy & Sleep Specialists in Hopedale, heads up the intensivist team. All of Milford Regional’s intensivists are boardcertified in pulmonary medicine, in addition to the separate requirements for critical care. Hospitals without certified critical care specialists overseeing their ICUs are most likely relying on internists or moonlighting consultants, said Dr. Curley. “If you use critical care specialists around the clock, compared to hospitals that don’t have them, there is a significant number of patients who live as opposed to die,” said Dr. Curley.

He describes critical care training as multi-specialty with intensivists learning about dangerous acute medical situations in a variety of areas, such as cardiology, neurology and post-operative care. According to Dr. Curley, critical care specialists are trained to administer procedures that the average internist wouldn’t have background performing, such as inserting endotracheal tubes, large venous catheters and dialysis catheters; removing fluid from around the lungs; and placing balloons in the stomach and esophagus to prevent bleeding. They also receive education in end-of-life decisions, explained Dr. Curley.

At Milford Regional, an intensivist is regularly in the hospital 12 hours per day and is available to work extended hours at night as needed. Each week, one critical care specialist staffs the ICU from 7 a.m. to 3 p.m. for a seven-day stretch. Because the physicians also practice pulmonary medicine and need to see patients at the office, another intensivist will take over from 3 p.m. to 7 p.m. Dr. Curley said this type of scheduled coverage is drastically different from hospitals that only use intensivists as consultants. “It’s much better to have people there continuously as things in the ICU happen at a rapid pace, rather than have a consultant come in and ask to be notified when the labs are in, and then not be available when paged,” said Dr. Curley.

At Milford Regional, he said an intensivist typically checks patients two times each day. Common reasons for an ICU stay include suicide attempts, drug overdoses, alcohol withdrawal, heart failure, pneumonia, Chronic Obstructive Pulmonary Disease, gastrointestinal bleeding, strokes, sudden kidney or liver failure, severe infections, and recovery after major surgery, said Dr. Curley. “We try to talk to the patient and families every day,” he stated. “We tell the families that one of us will be here every morning, and that they should just ask to speak with us and we’ll be glad to talk to them.”

Dr. Curley explained that intensivists act as conductors, coordinating care with what may be a half-dozen other specialists. In the past, Dr. Curley estimates that 50-60 patients per year were transferred to tertiary care centers, such as University of Massachusetts Medical Center. Now, that number has decreased to about a dozen patients per year who require extra technology at another site. “Milford Regional is evolving from a community hospital into a regional medical center,” said Dr. Curley. “They’re taking care of sicker people. In the future, we’d expect that there will be more intensivists hired and that critical care here will continue to grow.”

Patients need not be concerned about the quality of care provided at Milford Regional’s ICU versus a tertiary care center, assured Dr. Curley. In fact, Dr. Curley was previously the director of the ICU at UMass Medical Center, where he also headed the fellowship training program and trained many of the present staff.

“The people who come here are going to get the same quality of intensivist care they would get at a tertiary medical center,” he said. “To have one of our intensivists available all the time means we can care for sicker patients at Milford Regional than in the past. It’s a huge advantage for patients and their families. Parking is free, and we’re conveniently located for family and friends to visit their loved ones.”