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Sun Sep 7 14:32:43 BST 2008

We have 2 ICU's one surgical and one medical. All surgical patients are admitted to the surgical ICU and cared for by the Trauma/Critical Care Surgeon who is covering the ICU that week. Original surgeon has input on the care but orders are written by the T/CC ICU team. All trauma surgeons do general and trauma and are a part of the trauma team. 

New or difficult patients are discussed daily at the 0700 surgical conference. All patients that need to return to the OR are discussed at this conference and the original surgeon or the one most available will take the patient to the OR. "Who" does not matter since we work as one big team. Any disagreements are discussed and consensus obtained at that conference. Patients the require immediate return to the OR at night are taken back by the in-house trauma surgeon. 

We have only 6 General/Trauma surgeons who provide all of this care. VERY collegial relationship. Trauma volume about 3000 patients per year. (not as large as Pre-Katrina but population is gradually returning). Penetrating trauma is about 65 - 70 %. This does not count the general surgical patient volume. Same surgeons do the general surgery as well. Vascular and CT surgery is done by those specialist. Trauma surgeon does all the trauma except sheer injuries to the aorta. This is done by CT. We do have hand, ortho, OMFS, N/S, and GU available as needed. These are not in-house but have < 30 minute response times. We have in-house staff radiology and IR within 20-30 minutes

One last point to make...we also have a VERY collegial relationship with the Emergency Physicians. All major trauma is a joint participation resuscitation by TS & EM with the TS having the final decision as to when the patient goes to surgery, volume resuscitation, etc. We try to keep the major resuscitations to <10 minutes with the OR immediately available 24/7. Our goal for penetrating trauma is to have the ambulance arrival to incision times < 20 minutes.

I hope this detailed review of the Charity (MCL) Hospital service is a help to your deliberations

Norman

Norman McSwain MD
Trauma Director, Charity Hospital
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 

________________________________

From: trauma-list-bounces at trauma.org on behalf of kmattox at aol.com
Sent: Sat 9/6/2008 6:12 AM
To: Trauma &amp; Critical Care mailing list
Cc: Vernick, Jerome; Hanna, Niveen; Miller, Rick; Kountz, David MD; Garcia, Felix; lcbaker1 at mac.com; Malhotra, Atul, M.D.; Maldonado, Ivan; Ahmed, Nasim
Subject: Re: Surgical Intensivist Consultations

In tHe BTGH all patients admitted to the SICU are automaticaLly suegery patients.  All others are consultants.   Only the surGeon can wRIte orders.   Others can write a recommendation in progress notes.  

K

Sent via BlackBerry by AT&T

-----Original Message-----
From: "Dudick, Cathy" <CDudick at meridianhealth.com>

Date: Thu, 4 Sep 2008 10:50:46
To: <trauma-list at trauma.org>
Cc: Vernick, Jerome<JVernick at meridianhealth.com>; Kountz,  David  MD<DKountz at meridianhealth.com>; Miller,  Rick<richard.miller at Vanderbilt.Edu>; Hanna,  Niveen<NHanna at meridianhealth.com>; Garcia,  Felix<FGarcia at meridianhealth.com>; <lcbaker1 at mac.com>; Malhotra,  Atul, M.D.<AMALHOTRA1 at PARTNERS.ORG>; Maldonado,  Ivan<IMaldonado at meridianhealth.com>; Ahmed,  Nasim<nahmed at meridianhealth.com>
Subject: Surgical Intensivist Consultations

I have a question about the care of non trauma surgical intensive care
patients.

We are a level 2 trauma center with a busy SICU.  We the trauma
attendings(all double boarded in surgery/cc), provide 99% of the
critical care-lines, etc (no real resident/PA coverage at night).  We
and our surgery department support a formal policy of mandatory surgical
intensivist consultation for all SICU patients.  Our goal is to provide
24hour/7day intensivist in house coverage.  We feel this is in the best
interest of patient care. Also, it prevents us from "meeting" the
patient for the first time during a crisis, as we often are called for
septic shock, airway emergencies, etc, when no other intensivists are
readily available(mostly after hours and at night).  We would prefer to
be acquainted with the patients and perhaps treat small problems before
they escalate.  Lastly, it would help us manage our beds in the ICU.
The medical intensivists (private practitioners) do not stay in house,
but balk at the idea of a mandatory surgical Intensivist (hospital
faculty) consult policy for surgical ICU patients.

Who cares for that patient in your unit, the surgical intensivist, the
medical intensivist, etc?

Are your intensivists in house 24/7?

Do you have a written policy that mandates a surgical intensivist
consult for all admissions to the SICU?

Your input is much appreciated.

Cathy

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