Changing the Work Environment in ICUs to Achieve Patient-Focused Care: A Virtual Critical Care Department

Review all unit-based programs for improving quality and patients’ safety to ensure that collaboration and the evaluation of effectiveness are integral to each program.
Develop a fix-the-ineffective-work-arounds task force to identify and fix as many broken systems as possible. Uncover the root causes of the broken system by inviting and actively listening to input from nurses, physicians, and all affected care providers. Work collaboratively, inviting hospital and nursing administrators to participate in abolishing systems that do not work and designing effective new ones. there
Engage the executive leaders of the organization, including, as appropriate, the chief nursing officer, chief executive officer, and medical directors, in the challenge of transforming all systems for evaluating care providers to include the assessment of communication and collaboration skills. Be sure to reward successful skill acquisition in meaningful ways.
The virtual department of critical care at UMass Memorial Medical Center in Worcester, MA, is an example of creating a better model for delivering critical care services across the 21st century healthcare organization. In 2003, chief executive officer John O’Brien identified the need for a better model of delivering critical care. O’Brien charged a strategic planning committee with 21 interdisciplinary members with the daunting task of inventing the model and establishing guiding principles for implementation. After 13 months of deliberation, the committee presented its report to the chief executive officer and a leadership council that included the chairs of all clinical departments and the medical center president. With the unanimous support of the council, a new era of critical care began on September 1, 2004.
Critical care was defined as caring for critically ill patients regardless of the patients’ location in the system through a system-wide virtual department (Fig 1) that uses a collaborative, interdisciplinary, and patient-focused approach. All issues related to critical care are discussed by a critical care operations committee that meets every 2 weeks. The committee is composed of the entire critical care community; it is cochaired by a critical care physician specialist and the medical center director for critical care services.


Figure 1. Organizational chart of the “virtual” Department of Critical Care at UMass Memorial Medical Center. The Critical Care Operations Committee is composed of representatives of all groups with a stake in critical care; it is cochaired by a physician critical care specialist and the director of critical care services. Unit staff is composed of nursing and all clinical support services; eICU = a live, real-time telemedicine program; NICU = neonatal ICU; PICU = pediatric ICU; Neuro = neurologic; * = for critical care functions.

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