Teamwork, Care, Compassion & Organization

The intensive care unit is not merely a room or series of room filled with patients attached to interventional technology, it is the home of an organization: the intensive care team. This team – doctors, nurses, therapists, nutritionists, chaplains and other support staff, builds an environment for healing or dying. Each member brings different skills to the table - compassion is the common element.

Medicine, Care, Compassion and Organization

Critical Care is about medicine, care, compassion and organization.

The best intensive care units are the ones with the most effective management structures.

Patients are admitted to intensive care, for the most part, with one or more of the following problems: hemodynamic insufficiency, respiratory failure, abnormalities of fluid and electrolytes, sepsis and coma.

I frequently refer to the seven Cs of critical care:

1. Compassion
2. Communication (with patient and family).
3. Consideration (to patients, relatives and colleagues) and avoidance of Conflict.
4. Comfort: prevention of suffering
5. Carefulness (avoidance of injury)
6. Consistency
7. Closure (ethics and withdrawal of care).

Organization - so what? Intensive care units are minefields: potentially bottomless financial pits, brimful of - mythological practices, conflict between teams of doctors, nurses and support staff, inevitable excess of demand over supply of beds, tons of paperwork, billing, changing prescribing practices, along with a  mountain of journal material to analyze. It is not possible to build an effective critical care practice without high quality management which addresses the following issues:

1. Environment (patients, staff and visitors). 2. Organization Structure (multidisciplinary). 3. Teamwork. 4.Gatekeeping (appropriate bed usage). 5.Evidence based practice and cost effectiveness. 6. Continuous Education. 7. Audit with transparency.

Every good intensive care unit will have one or more medical and nursing directors, perhaps a business manager and very strong pharmacy and infectious disease backup.

Critical care is characterized by a very high doctor and nurse to patient ratio. In most units, a very heavy burden of experience is placed on the shoulders of the nursing staff, and chaos will result if there is not a strong collegial relationship between the doctors and the nurses; the latter are the primary caregivers and spend a large amount of their day looking after one or two patients. Ignore their concerns at your peril.

Your first step to become a critical care practitioner is to understand critical illness.

The next section begins and explores a philosophical approach to critical illness which we will recurrently revisit during the course of these tutorials.

Please note: these tutorials are for personal study purposes only.  They are not currently peer reviewed, and no responsibility will be taken for mistakes or inaccuracies. Reproduction of information is forbidden. All material is copyrighted by the GasWorks Group.