As you know,
the idea of having an Intensivist in SJMC has often been thrown around over the
years but nothing concrete has been done about it. Partly because some of us
feel that we prefer to look after our own patients post-operatively and also
because of the lack of a suitable candidate.
Well, recently, Dr. Jacob Thomas, our director, has been making inquiries into the possibility of bringing in an Intensivist into our hospital. I get the distinct feeling that there is possibly an applicant with presumably suitable qualifications who is interested to be an Intensivist here.
I suppose such a pratitioner, if brought in, will look after all the patients in ICU and CCU. If he is not allowed to care for all the patients in these special care wards, it is difficult to see how he could earn his keep. I know that some of us have a dislike for intensive care work and these anaesthetists would obviously welcome such an Intensivist.
However, there are others who feel very strongly that it would be in the best interest of the patient if the anaesthetist who anaesthetised the patient were to continue to manage them in the ICU/CCU.
This is a tough one and I have rather mixed feelings about this.
I suppose overall with our workload at its ebb now, it would be foolhardy to get someone in and cut down even further on our income.
Also, there is a lot to be said for continuity of management of patients especially in the post-operative phase as we are the ones who have seen the patient pre-operatively and also managed him right through his operation and recovery period.
Cardiac arrests are probably best handled by a person who is always available for this and this would be a good reason to get an Intensivist.
While epidurals are not my favourite cases to do at 3:00 a.m. in the morning, they do form a sizeable portion of our income during these lean times as obstetrics had proven to be one of the specialties less affected by the recession.
On the whole, I see it would be difficult for an Intensivist to survive just on cardiac arrests and the occassional referral from the physicians. My vote would therefore have to be a NO.
2 of 4 Intensivist may be a good idea
From: gasline
Date: Feb 23 1999
Note:This message is in fact submitted by bobbyphtan
I personally have no objections or reservations for an intensivist (to be in SJMC). In fact I think it would benefit patients, staff and all round effeiciency.
As it is sometimes managing an ICU patient thru the phone when one is held up elsewhere is not optimum care. An intensivist would lend a closer hands on approach. The problem would be after hours. Who looks after the patients then. Cannot expect the man to be on call around the clock. Probably can be ironed out.
In all probability this person would be an anaesthetist who would probably participate in the emergency anaestheic roster and do a list or two as well. Can be worked out.
3 of 4 Not in Favour
From: gasline
Date: Mar 24 1999
Submitted by Mary
I personally would prefer to look after my own patients in ICU for the sake of continuity of care. If they need an intensivist,I would assume he would look after patients where the anesthetist does not want to look after. I am not sure if the idea will go down well once primary physicians see the bill for the intensivist. Then again they might want him in so that they can sleep well at nights and let the nurses call up the intensivist for all the problems.
The only time I feel there may be the need for 'someone around' is the babies who self-extubate and the nurses are left having to cope with that. Does not happen often but has happened.
I dont know how this intensivist will survive financially as we do not have the volume which would pay to have a person like that around. Unless the hospital wants to employ him of course. Most of the set-ups locally, I think have the anesthetists involved like we do.
What we need, more than an intensivist, would be a COMPETENT medical officer (Who can intubate babies and adults) who is free to run around the hospital fixing drips etc and covering the ICU/CCU for urgent situations where the consultants are not available just yet. There might be enough work for such a person rather than a fulltime intensivist. It would also be easier for us as consultants to leave instructions to such a person rather than an intensivist who might countermand your instructions!
The thing I am trying to say is that theatre work and ICU work usually feed each other,with the other aspect of medical ICU problems.
4 of 4 intensivist
From: gasbach
Date: Apr 26 1999
In principle I agree that someone who specialises in a particular field is
the best person to handle a problem.
However I see a few problems which we will have to look at.
Medico-legal
eg especially when things go wrong in OR and the case is passed to another
clinician.
Primary physician
Will this change once under intensivist
On call cover
Will the person be able to cover all the code blue and ICU calls or will we be
doing all this and pass the cases to him the next morning? Lets face it even
with one bad case on ICU we can get knackered, if an intensivist is going to
look after let's say 10 cases I doubt if he can cope. So we will end up having
to cover the ICU emergencies/code blues etc while on call. In such a situation
we may actually end up doing an MO call for an Intensivist. I am a bit
apprehensive about having a situation where an Intensivist looks after ICU but
if a baby self extubates at 0400 hrs the first on call still has to rush in as
the Intensivist can't be on call every night?
Perhaps the Intensivist should have an ICU team with his own rostered MOs .