A conversation with one of my listeners, Kevin Jordan, an ICU Doctor. We discuss what should happen with some categories of gray zone admissions to the ICU. Let me know what you think…
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Yes – this (early expert resuscitation and critical care) may actually be the greatest bang for buck for our patients. Categorize the shock state accurately. Source control. Appropriate monitoring. Avoid iatrogenesis. Control the airway not too early, but not too late, etc.
Once someone has well established critical illness, stuck on a vent, deconditioned, there is often little magic we can do to alter their course.
It is nuanced, no? Are they sick now or could they get sick? Different questions. Neutropenic patient with a favor but stable? Cirrhotic with history of GI beed in for pneumonia? Stable patient, no interventions needed but at risk to decompensated? I’d say no. If they are already receiving interventions that are appropriate for their level of care I’d say no. If they are looking like some things have been tried but it could get out of hand quick, then yes.
I would love to join this discussion as a 17 yo nurse. I’ve done tele and icu. It’s about growing your tele nurses to feel more clinically comfortable to make rapid and appropriate decisions. So much to say on this subject
How do you convince hospital administration to “upstaff” to a step down unit to take care of sicker non-ICU patients when they seem to be wedded to the 5:1 or 6:1 nursing models on the floor? Like many community hospitals, half of our patients don’t need a hospital bed but need a RN that can check on them a couple times per day and give meds. Those patients are mixed with the sicker patients who really do need more intensive nursing and monitoring. Yet we can’t get the administration to consistently staff a step down unit. The 3:1 or 4:1… Read more »
Great banter. Idk if a session with a couple EMCrit regulars would best be used discussing what should be admitted to an ICU or what should not- and are they necessarily polar opposites. As many others I’d love to see ICU/PCU or go home. For me it’s even worse with the “they could get worse” comments from the hospitalist because that means an air transfer which is a whole different level of resources. Still waiting for the 1 ED-ICU bed I’ve been campaigning for Scott. 🙂 hopefully another podcast session will be forthcoming
Interesting discussion. Not sure why there is such disparity in ICU admission criteria. Our hospital cohorts DKA patients on insulin drips on one floor and staffs accordingly – we admit severe DKA (pH<7) or comorbidities. THey don’t even go to a stepdown bed. WE have a hard enough time taking all the critically ill without admitting patients who “might decompensate”.
Scott mentioned that the UNM hospital has only ICU and step-down beds with almost no general medical beds. Does anyone know of any other hospitals trying this model? Or any materials supporting it? I’m coming up blank trying to find more info in the internet.
In small full rural hospitals, when I can’t transfer sick people out to higher level of care, I’m inclined to take patients in to our ICU/IMC beds sooner rather than later, or the pt is really screwed. When they get worse.
And haven’t wasted an ICU bed on a Precedex dementia pt since COVID, LOL! And I take care of them in either location. Besides, it is taking so long for SNF’s to take them, that gorking them out on Zyprexa and Loraz doesn’t delay discharge anyway, now.