Leading the Way
Studies show that when critical care is delivered by intensivists, patient outcomes improve.
Overlake’s Intensivist Physicians Collaborate to Offer Top-Quality Care for the Critically Ill
Few people ever imagine that they will find themselves in a hospital’s critical care unit. But if you or a loved one becomes medically unstable due to a life-threatening injury or illness, intensive care is crucial. The Critical Care Unit (CCU) at Overlake is a state-of-the-art facility where a dedicated multidisciplinary team cares for the most vulnerable patients.
On January 3, Overlake took an important step toward making its award-winning CCU even better: It became the only hospital in the greater Seattle area to provide onsite coverage in the CCU by intensivist physicians who are board certified in critical care medicine. Intensivists are trained to treat a broad range of complex medical conditions and possess unique skills for performing specialized bedside procedures.
At Overlake, a team of nine intensivists now provides onsite coverage, ensuring there are always two intensivists in the CCU during the day and one throughout the night. (The CCU staff previously had telephone and on-call access to intensivists in the evenings.)
At many hospitals, intensivists are available to the CCU staff through an e-ICU system, which is a video hookup that allows intensivists to provide after-hours consultations from a remote location. In contrast, having an intensivist onsite at Overlake at all times offers substantial benefits to patients. “Critical care problems don’t follow bankers’ hours,” says Bill Watts, MD, an intensivist at Overlake. “If an intensivist is present, it contributes to recognizing serious disease or deteriorating situations right away.”
“In the CCU, medical conditions can change very rapidly,” adds Rob Sandblom, MD, another Overlake intensivist. “Every week, if not every day, an event will occur that shows the advantage of being at the bedside, whether it’s dealing with an arrhythmia (irregular heartbeat), shock or a respiratory problem. While remote technology allows us to view much of this, being physically present to examine the patient, listen to the patient and talk to his or her family adds significantly to the quality of care. Having a highly knowledgeable doctor at the bedside also makes a difference in terms of being able to safely move the patient out of the CCU faster.”
The intensivist acts as the team leader, working closely with surgeons, hospitalists, nurses, therapists and other staff to make sure the patient is getting the best possible care. “It’s analogous to an airline,” says Dr. Sandblom. “A team gets the plane from one place to another safely, and the pilot is only one person on that team. As a good leader, you listen to everybody on your team.”
The 24/7 Difference
Patients in the Critical Care Unit receive round-the-clock coverage by board-certified intensivists. Here are a few of the patient advantages:
- When a medical emergency occurs, a doctor who is board certified in critical care is available to provide care in person.
- Studies indicate that patients who receive care in hospitals with an intensivist program have improved outcomes, lower mortality rates and shorter hospital stays. Research also shows that 24-hour, in-house intensivist coverage is superior to on-demand availability.
- Intensivists coordinate care among specialists, nurses and other staff, ensuring that the entire team is following the same strategy.
The Intensivist Team
- Scott Bonvallet, MD
- James Copeland, MD
- Matt Fei, MD
- Todd Freudenberger, MD
- Eric Gottesman, MD
- Amy Markezich, MD
- Michael Puruckherr, MD
- Rob Sandblom, MD
- Bill Watts, MD
Having coordinated care is key when treating patients such as Pete Talevich, who was in the midst of law school when he developed acute respiratory distress syndrome, a life-threatening condition that prevents oxygen from getting into the bloodstream. “I felt sick for weeks,” Talevich recalls. “I was not in good shape at all. I wasn’t getting enough breath into my body.”
After arriving at Overlake’s Emergency Department (ED), Talevich was admitted to the CCU and placed into a medically induced coma as doctors worked to usher him back to health. When he awoke, he couldn’t breathe without mechanical ventilation, but he discovered that Todd Freudenberger, MD, and Dr. Watts were spearheading his care with precision.
“Every pulmonologist was involved in my case, but they were the front men,” Talevich says. “They told me what they were doing and how I was going to get better. There was a lot of problem solving that had to occur because it was a serious situation that didn’t lend itself to an easy solution. Nurses would say, ‘Dr. Watts and I discussed this,’ and it was the same with the respiratory therapists. Their opinions would be informed by Dr. Freudenberger and Dr. Watts.”
Key to Talevich’s recovery was a respiratory therapy program designed to strengthen his lungs. Along the way, the successes were small but significant. “There were times when I would be able to do something that I hadn’t been able to do the day before,” Talevich remembers. “I would be able to walk around the hospital one more time or be off the ventilator for five more minutes. I felt that I was making progress.” And indeed he was. After spending nearly three months in the CCU, Talevich was deemed well enough to return home, where he would recuperate while receiving home physical therapy. Three months later, he was back on campus at Seattle University Law School.
Studies show that when critical care is delivered by intensivists, patient outcomes improve. “Until the mid-’80s, general internists managed all patients in critical care, but it became obvious that there were features of critical care that required more specific training,” says Dr. Sandblom, who was one of the first doctors in the country to become board certified in critical care. “Like any other specialty, critical care evolved because of a need.”
At Overlake, intensivists admit nearly all of the patients who arrive at the CCU from the ED. Dr. Freudenberger was one of the first doctors to see Talevich when he arrived in the ED and was involved with his care every step of the way.
The intensivist who is onsite also participates on the Code Team, which provides life support in a cardiac emergency. “That improves outcomes because we have two physicians responding instead of just one,” says Dr. Freudenberger.
The Power of Teamwork
Many Overlake patients are members of the Group Health Cooperative, and three of the hospital’s intensivists are Group Health providers. “For many years, Group Health and Overlake were friendly competitors on the Eastside, but several years ago, we decided to combine resources,” explains Dr. Sandblom. “It’s been very successful because Group Health has some very strong points and Overlake does too, and we’ve been able to learn from each other. So, we function side by side, caring for both Group Health and non–Group Health patients. The philosophy is that we simply share the work without the burden of concern of where the insurance is coming from. We care for the patients first and figure out the business aspects of it afterward.”
Working in the Critical Care Unit requires laser-quick instincts and the ability to handle a broad range of medical crises, but intensivists such as Dr. Watts say the rewards can be significant. “You always remember the patients who had devastating diseases, but, due to extraordinary efforts by the team — and I really emphasize the team — they recover and get back to their normal life,” he says. “After spending a month or two, or even three, in the CCU, against all odds, they pull through.”
In fact, Pete Talevich did just that, then graduated from law school and garnered a job at a top Seattle law firm. “I’m feeling really well,” he says. “I have plenty of energy, and I’m able to work full-time. The intensivists were very knowledgeable about my entire case and how to treat it. I’m so glad that I happened to be in this area when I was admitted to the hospital because I couldn’t have received better care anywhere else.”