Recognizing May as Critical Care Awareness Month provides a timely opportunity to reflect on the wide range of providers who care for the critically ill.
No two paths to critical care medicine are identical, and the environments in which clinicians practice represent a diverse range of geographies, facilities, organizational challenges and clinical and personal experiences. It strikes me that despite the significant diversity of our individual realities, we share a set of common challenges that unite us in shared experience and purpose.
Consider, for example, the hospitalist in a small rural hospital, who cares for complex patients in the ICU without easy access to intensivist subspecialty support. He is challenged to provide the best care for his patients but knows that this means certain patients will need to be transferred to other, larger hospitals for more advanced care. He struggles to identify the limits of his own comfort and expertise as he recognizes that transfer presents significant hardships to his patients and their loved ones, who would prefer to remain close to home, and he also understands the hospital’s preference to retain revenue while prioritizing patient safety.
Or the intensivist practicing in a busy urban hospital, with a steady flow of patients crowding the ICU and more being held for prolonged periods in the ED because of the lack of ICU bed availability. She and her team need to address a wide range critical care needs across a diverse patient population in a high patient volume context. Focused on providing timely care for each patient efficiently in an environment resource constrained by ICU bed availability, she is constantly working in the face of competing priorities, solving triage and bed-flow related operational challenges while meeting the immediate critical care needs of a high acuity ICU patient population.
Imagine the CMO in a mid-size hospital system, evaluating ICU performance across system hospitals but lacking sufficient consistent data for in-depth analysis. He is generally very satisfied with the quality of patient care, as best he can measure it, provided through the highly-resourced intensivist staffing model he has built, but remains extremely concerned about intensivist burn out. He knows that the hours and demands faced by his intensivist teams are unsustainable. In addition, the severe intensivist supply and demand mismatch is concerning and he is unsure that there are realistic solutions, from a cost and quality perspective, to the intensivist turnover he sees on the horizon.
Finally, there is the tele-ICU provider, skilled in critical care and primarily caring for patients remotely by partnering with bedside teams of physicians and nurses. Focused both on immediate needs and driving specific best practices, the tele-intensivist is challenged to collaboratively care for a diverse population of medically complex, critically ill patients in a very wide range of contexts in terms of culture, technology, processes and resource availability. Engaging and building rapport among distant colleagues requires a robust skillset that includes both teamwork and team leadership.
Despite the significant personal, professional and situational differences, these disparate individuals are unified by the need to address healthcare at its most challenging. They are all invested in making a significant difference when the stakes are highest, the patients at their most vulnerable, and the pace most hectic. Across a diverse landscape of hospital settings, critical care providers share a common call to provide the best possible care for the most critically ill patients in their hospital. Each weathers the intellectual and personal toll of wrestling with tough conditions and situations, both clinical and emotional. Each is daunted by the magnitude of their responsibilities, humbled by the trust of their patients, and fulfilled by appreciation from patients and families.
In the end, we are united by the desire to provide the best possible care, to see our patients recover and return home, and to ease pain and uncertainty as efficiently and compassionately as we realistically are able.
As Critical Care Awareness Month draws to its close, it seemed an appropriate time to accentuate the joys and challenges of the special work that we share and to honor those who commit to the highest level of critical care.