THE UP-PGH CENTRAL ADULT AND PEDIATRIC IN TENSIVE CARE UNIT (CENICU): AN OVERVIEWJUBERT P. BENEDICTO, MD , FPCP, FPCCPPulmonary Critical Care SpecialistPast Head, UP-PGH CENICUPast Chair, UP-PGH CCU-MATUniversity of the Philippines, ManilaICU Mission preserve meaningful human life by protecting and sustaining patients in a caring manner when they are threatened by an acute critical illness or injury provide specialized rehabilitative care to ICU patients as they start to recover from their critical illness or injury provide compassionate and attentive care to the dying and their families

ICU Resource and Organization The ICU, after the operating room is the most important consumer of resources in the hospital, per patient and per unit of time. Intensive Care Med (1991) 17:127-128 As care has become more complex for the critically ill patient, mechanisms to integrate complex behavior into a functional whole have become increasingly important. Fink, Textbook of Critical Care, 5th ed. Copyright 2005 Saunders

CENICU: background Established in 1993- initially, patients were from MICU has evolved into the present unit consisting of 15 beds (11 pay; 4 charity) Only area in PGH for critically-ill pay patients Attempted to have other specialties involved serve the very sick patient with the same zeal, compassion, and combined with specialized care using modern technology and updated medical knowledge and skills.

CENICU Vision StatementThe Central Intensive Care Unit of the Philippine General Hospital see itself as an excellent provider of intensive care for patients with multiorgan dysfunction or failure

CENICU Mission StatementWe commit ourselves :To provide quality care with quality speed to critically ill patients while adhering to the policies and guidelines of the different units of the hospital

QUALITY OBJECTIVESCUSTOMER/CLIENT SATISFACTION Attainment of at least 3 or satisfactory rating on the customer/client evaluation. Reduction of customer complaints by 20% within the 2nd semester of the year. COMPLIANCE WITH REGULATORY REQUIREMENTS Compliance of at least 80% with the requirements set by each governing body. Quality patient care Rational staffing complement Volume statistics Infection control Adverse/sentinel events Morbidity/mortality rates Timely delivery of health care

Organizational StructureNursing and Paramedical StaffSupervisor- 1Charge Nurse -3Staff Nurses -27Administrative Officer-1Nursing Aides- 8

Medical StaffAttending Physicians (Open ICU): >1/patientICU Head: 1Pulmonary Fellow: 1Medical Resident: 3

Medical Staff Closed ICU setting: dedicated staff of intensivists man the ICU, and main attending physician relinquishes service to the ICU consultant/service upon entry of patient to the ICU Open ICU setting: Attending physician(s) maintain(s) service even while in the ICU

Baggs Components of Collaborative Practice cooperation assertiveness shared decision-making communication joint planning coordination Characteristics of Multidisciplinary Approach to ICU Care co-responsibility of medical and nursing directors nursing, RT, and pharmacy collaboration with med staff use of standards, protocols and guidelines coordination and communication in all aspects practitioner certification, research, education, ethical issues, and patient advocacy Implementing Collaborative Practice administrative function: team organized define nature of population skills training and enhancement controlled access managerial factors: programming and feedback mechanisms

POLICIESCriteria for Admission according to priority : Priority 1 Postoperative or acute respiratory failure patients requiring ventilatory support, and shock or hemodynamically unstable patients receiving invasive monitoring and/or vasoactive drugs.

Criteria for Admission according to priority : Priority 2 Patients with co-morbid conditions who develop acute severe medical or surgical illness like diabetes mellitus, hypertension, CAD, chronic renal failure, CVD and liver cirrhosis.

Criteria for Admission according to priority : Priority 3 Patients with metastatic malignancy or CA complicated by infection, airway obstruction or cardiac tamponade.

Criteria for Admission according to priority : Priority 4 Little or no anticipated benefit from ICU care based on low risk of active intervention that could not safely be administered in a non-ICU setting Patients with terminal and irreversible illness facing imminent death (too sick to benefit from ICU care).

Specific Diseases Needing ICU Admission Contraindications for Admission: Grossly infected lesions without cardiopulmonary problem. Infectious cases such as Meningococcemia, measles, Mumps, Rubella, Adenovirus, Varicella or Disseminated Zoster, rabies and Influenza that requires isolation Hepatitis B and C without cardiopulmonary problems. Diagnosed cases of active PTB (Class III), HIV and AIDS

Outcomes of collaborative practice Patient outcomes: better patient care, cost-effectiveness, and improved satisfaction Nurse outcomes: more productive and efficient; more time for research and self-improvement Physician outcomes: increased efficiency and job satisfaction; less medical errors; better understanding of other team members Administrator outcomes: health care costs lower due to higher efficiency, shorter hospital stay, fewer patient complications Collaborative Practice in Action Acute stroke team Neonatal care team Outcomes management team Family involvement or collaboration End of life comprehensive support team Patient safety team (addition of pharmacist) Management of ICU Resources ICUs tend to adapt organization and resources to outputs optimal distribution of resources demands that each ICU organization be determined and controlled according to established national regulations effective regionalization of CCM is only possible if the knowledge and practice of CCM essentials are known by staff

OTHER COLLABORATING DEPARTMENTS/UNITS: We are under the Office of the Deputy Director for Health Operations Nursing Paramedical staff Physicians-in-training Pharmacists Infection Control Unit

Conclusion The ICU is a complex, scarce resource unit but cost-intensive unit Efficient management should be done to improve and maximize patient benefits The UP-PGH CENICU is just one model out of several options You may adapt several models that will suit your hospitals needssystems and methods Admitting Procedures:A.P. RequestICU Admission fromE.R. or WardNurse of referring Unit notifiesICU NursesAccounting Dept. ClearanceWritten ConsentsPatient needs relayed to ICUTransfer/admission to ICU based on

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systems and methodsTransfer and Discharge:A.P. ordersTransfer/dischargeTo FloorICU Nurse notifiesNurses in FloorAccounting Dept. ClearanceTransfer SlipCompletedPatient must be accompaniedby ICU NurseTransfer/admission to Room in Hospital Floor

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