Success in Rhode Island

How one organization successfully implemented an integrated team of dedicated experts in its ICU.

Newport Hospitals' ICU team (above) successfully implemented a combined intensivist/hospitalist program through their unwavering dedication.

Implementing the intensivist model at Newport Hospital in Newport, Rhode Island, has been a fruitful experience, with the hospital administration and board of directors ardently backing patient-centered care and the intensivists who deliver it.

“The intensivists provide outstanding care to all of our traditional level intensive care unit (ICU) patients and are now caring for patients whom we would have transferred to other facilities in the past,” says Arthur J. Sampson, president and chief executive officer of Newport Hospital. “Having the capability to provide this high level of care in our community has been very beneficial to patients and families. The intensivist model also promotes greater contact and less travel. We feel that this capability will ultimately translate to a heightened professional image and profile for Newport Hospital.”

In 2001, ICU Director Hussain M. Dhanani, MD, was hired by Newport Hospital in conjunction with The Miriam Hospital to implement both an intensivist and a hospitalist program. Newport Hospital, a community-based, 127-bed hospital with a 10-bed mixed medical surgical ICU, and The Miriam Hospital in Providence, Rhode Island are partners in the Lifespan Health System.

“Sharing responsibility with the hospitalists offers a way for this program to survive, sustain, and grow,” Dr. Dhanani comments. “The intensivists and hospitalists manage most of the internal medicine patients. The intensivists generally care for the sicker patients and the hospitalists see rehabilitation patients and those patients on the floor who are not critically ill. Though the intensivists and hospitalists have joined together, both disciplines eventually will evolve into discrete models.”

Newport Hospital’s ICU nurses and respiratory therapists have access to a central pharmacist, as well as a computerized dispensing system. Hospitalists, including three intensivists, cover the ICU 24 hours a day and are present in the unit at least 12 hours a day. Because a hospitalist is always available on site, he or she can be quickly summoned to an ICU bedside when needed.

The ICU still officially operates on the open system, but intensivists manage most patients, especially those who are critically ill. “Now it is fairly routine for a doctor admitting a patient to the ICU to have an intensivist pick up the patient and relinquish care to the intensivist until the patient is sent to the hospital floor, rehabilitation or home,” says Dr. Dhanani.

“This group has really grown through the encouragement
and support of the administration to care for
patients at a level that should be the standard of care
throughout the country.”

The ICU census dropped dramatically within the first three months of the arrival of the first intensivist. Dr. Dhanani believes this was due to fewer iatrogenic admissions. He noted that ICU admissions have trended upward over the last three years, in keeping with community growth and the aging population—demonstrating the need for a dedicated intensivist program.

“For a small hospital, the intensivist model is not easy to afford,” says Dr. Dhanani. “Newport Hospital’s administration understands that the upfront cost has been invested to save money and lives in the long run.”

Mr. Sampson goes on to explain that “Newport Hospital has long believed that critical care support for our medical staff was essential for our mutual success. Our earliest efforts started when specialists with the most critical care expertise were pulmonologists,” he says. “A pulmonary group from another town provided excellent support but was not always immediately available. As the specialty of critical care grew, we started discussions about a joint coverage program with The Miriam.”

Shortly thereafter, the Leapfrog guidelines were promulgated, further highlighting a recognized need for intensivists. In the interim, the maturing hospitalist program was expanded to include several critical care specialists who provide both primary and consultative services to patients and staff in the emergency department and telemetry units, as well as in the ICU. “Their services have been a tremendous benefit to our patients and staff,” adds Mr. Sampson.

“The hospital administration has brought the intensivists into decision making roles,” says Dr. Dhanani, a member of the hospital’s board of trustees. “This group has really grown through the encouragement and support of the administration to care for patients at a level that should be the standard of care throughout the country.”

Newport Hospital serves one of the largest indigent populations in the state of Rhode Island, which places a tremendous strain on the community physicians who staff the hospital for admissions and inpatient management. Consequently, the administration decided to dedicate hospital physicians to this task. The hospitalists now care for 50 to 65 indigent patients, which is more than half of the hospital census at any given time.

Dr. Dhanani notes that the intensivists and hospitalists are well accepted by Newport physicians and staff. He believes that this is partly due to their role in treating indigent patients. “It had come to the point where the community physicians wanted a hospitalist program to take over indigent patient population care. At that point, they had not realized what intensivists could do for them, but are now appreciative and accepting,” he says.

“The intensivist program is well accepted by the nurses because it really is multidisciplinary, which allows us to look at the whole picture,” explains Margie H. Dunbar, RN, MS, CRNI, director of critical care. In addition, the constant presence of intensivists and hospitalists has improved the delivery of patient care.

“It is wonderful to have intensivists and hospitalists at Newport Hospital 24 hours a day. They are able to see patients immediately, and we do not have to wait for phone calls to be returned. Most of these physicians are willing to educate the nursing staff on the interventions, which is also very helpful,” she continues.

“To bring about this type of cultural change is really quite a challenge, and we have accomplished it in less than three years,” concludes Mr. Sampson.

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Editor's note: The Society is seeking similar success stories about implementing the multidisciplinary team model by its members. Because implementing the model is often a challenging task, sharing your experience may help other intensivists overcome similar obstacles to the ones you faced. Your experience will also help SCCM highlight the fact that the multidisciplinary team model can work in any setting and that the intensivist can work effectively with other healthcare providers.

These stories will be collected and published by SCCM as a resource to its members and other healthcare practitioners. To contribute your story to this project, please contact Elaine Salewske, Marketing Communications Manager at (847) 827-7095 or esalewske@sccm.org.