The Society of Critical Care Medicine (SCCM) calls its patientcentered philosophy of critical care delivery Right Care, Right NowTM. The idea is that patients get the care they need from a trained, integrated team of critical care experts directed by a trained and present physician who is credentialed in critical care medicine. Members of the multiprofessional team work together to deliver appropriate care without delay.
“Right Care, Right NowTM is a team philosophy that we adopt when a patient crosses the ICU threshold,” said SCCM Past President Timothy G. Buchman, PhD, MD, FCCM. “Before the patients arrive in the ICU, they have interested caregivers who are doing their best as individuals, but when patients enter the unit the individuals become a team that functions effectively according to the Right Care, Right NowTM principle.
The integrated team focuses on a shared goal—the best care for the patient.
Each person understands his or her contribution to care and interacts with other team members
accordingly.
The Coalition for Critical Care Excellence has played a key role in SCCM’s strategic planning process over the last five years. Barry Shapiro, MD, FCCM, chair of the Coalition, recalls that, “the question of what was actually meant by the ‘intensivist-directed model’ emerged during the planning process. When we posed that question to the leaders of SCCM and the American College of Critical Care Medicine, each answer was unique to the individual.”
Recognizing that a consensus meeting was needed to define the critical care delivery model, the Coalition funded a two-day retreat devoted to this priority issue. Leaders from the Coalition, the SCCM Executive Committee and the College met in Miami Beach in January 2004 to discuss the intensivist-directed model and to decide how SCCM should accelerate its adoption.
“As we discussed the best way to care for the critically ill, we began to focus on the patient rather than on a particular provider. Our attention shifted from the intensivist to the team,” SCCM President Margaret Parker, MD, FCCM, recalls. “That’s how the Right Care, Right Now™ concept developed.”
The core team consists of intensivists, critical care nurses, critical care pharmacists, respiratory therapists and “other professionals.” Teams might also include physician assistants, primary care physicians, consultant medical specialists, social workers and ethicists. The combined knowledge, technology and compassion of the multiprofessional team ensure timely, safe, efficient and effective patient-centered care.
“What we do in the ICU as a team cannot be found elsewhere in the hospital because the diseases and injuries we treat are life threatening.” Buchman notes. “We can’t pause for eight hours until daylight or wait a day or two for cultures to come back. We are dealing with patients who are actively deteriorating or at high risk of deteriorating. We have to put interventions in place as soon as possible to minimize the long-term consequences. Right Care, Right Now™ embodies this philosophy of timely, integrated care. It unites us as critical care professionals despite our professional diversity.”
“Everything we do—quality improvement, continuing medical education, research—is for the good of the patient,” Buchman insists. “We have to integrate everything we have learned through study, research, clinical experience and professional interaction to that end. That means delivering the right care, right now, with no competing, higher obligations. When you are on service in the ICU environment, the person in the bed is your highest priority.”
Right Care, Right Now™ Is Right for the Society
Dr. Parker notes that by linking quality and timeliness of care, Right Care, Right Now™ supports SCCM’s mission of providing the best care for all critically ill and injured patients.
“There is overwhelming clinical evidence that the integrated team of dedicated experts is the best practice model for an ICU,” says Phil Weinfurt, PhD, vice chair of the Coalition for Critical Care Excellence. Dr. Weinfurt wants SCCM to urge its members and hospital administrators to adopt the Right Care, Right Now™ model nationwide as soon as possible.
Rolling out Right Care, Right Now™
Dr. Parker calls Right Care, Right Now™ an “intuitive” philosophy. “We are all here for the good of our patients,” she says. “The best way to bring the concept forward is to publicize it to both the medical profession—all healthcare providers, including critical care professionals—and to the public. The lay public needs a better understanding of what happens in an ICU.” During her presidential term, Dr. Parker has worked hard to have the Right Care, Right Now™ patient-centered philosophy permeate SCCM and all of critical care.
Dr. Buchman suggests that SCCM members ask themselves the following questions: “How do I know that the care I am delivering as an individual and that we are delivering as a team is the right care? How am I measuring the effects of my care? How do I know that care is being delivered in the most timely way? How do I know that lifesaving interventions are being done right now? How do I know that antibiotics are being delivered within a few minutes of their being ordered? How do I know that x-rays are being taken so I can evaluate the patient’s respiratory distress in a timely fashion?”
“If we rally around this philosophy of Right Care, Right Now™, we will move the organization forward and improve our individual practices,” Dr. Buchman says. “With its emphasis on the patient rather than the providers, on the multiprofessional team rather than the uniquely trained individuals, the campaign is an opportunity for us not just to talk the talk, but also to walk the walk.”