Right Care, Right Now™ !

Margaret M. Parker, MD, FCCM

If you were critically ill or injured, who would you want taking care of you? Probably most of us don’t think about this question, but those of us who spend some or all of our professional time caring for the critically ill instinctively know the answer. We would want a team of critical care professionals at our bedside. Have you thought about the qualities of the team that you would want?

Critically ill or injured patients need the “Right Care, Right Now™” if we are to achieve optimal outcomes. Many different skills are required to care for a critically ill patient. An integrated team of dedicated experts provides the skills that are needed to reach the desired outcomes. The team includes a large variety of healthcare professionals, all of whom bring a different expertise or skill to the care of the patient. Team members may include intensivists, critical care nurses, respiratory therapists, pharmacists/pharmacologists, physician assistants, social workers, dietitians, ethicists, chaplain, physical, occupational and speech therapists, primary care physicians, and consultant medical specialists. The team also includes the patient and family members.

What is an integrated team of dedicated experts? “Integrated” implies sharing of knowledge and expertise. Integration requires open communication. Many medical errors occur due to a failure of communication. An atmosphere of open communication is one of the essential steps in improving outcomes in critical care.

A “team” requires true collaboration. In order to function as a true team, each member must have respect for each other and work toward a common goal. True teamwork not only produces better patient care, it also creates a better working environment and better patient and family satisfaction.

Being “dedicated” involves a commitment to both the care of the patient and to the functioning of the unit. The dedicated expert, when assigned to the intensive care unit (ICU), has no higher obligations than the care of critically ill patients. The immediate availability of the needed expertise is essential for optimal care in the ICU.

Dedicated “experts” in critical care are trained and competent. They are educated in critical care, certified as applicable in their field, and experienced in the care of the critically ill. The critical care expert, quite simply, knows howto care for the critically ill or injured patient.

Every team must have a leader, and in the ICU, the intensivist has the training and competence to lead the team. The intensivist, however, cannot provide all of the care for the patient alone; all of the team members are needed. The primary focus of a truly integrated team of dedicated experts is on the patient, not on the specific types of providers. The goal is safe, efficient, effective, patientcentered care. The integrated team of dedicated experts is the mechanism by which that goal, optimal patient outcomes, is most likely to be reached.

Return to the initial question – what qualities would you want in your critical care team? I want my team to demonstrate open communication, respectful collaboration, commitment to the patient and to the intensive care unit, and competence in critical care.