Jacobs Journal of Emergency Medicine

Challenges Confronted in ICU Management

*Saranya Nagalingam
Department Of Community Medicine, Velammal Medical College Hospital And Research Institute, Tagore Medical College And Hospital, Tamilnadu, India

*Corresponding Author:
Saranya Nagalingam
Department Of Community Medicine, Velammal Medical College Hospital And Research Institute, Tagore Medical College And Hospital, Tamilnadu, India
Email:dr.n.saranya@gmail.com

Published on: 2019-01-22

Abstract

An intensive care unit (ICU) is a section of the hospital that provides special care for patients who are critically ill and who can benefit from Intensive Monitoring and proper timely treatment. Patients get round-the-clock care by a welltrained team which includes Intensivists, Specially trained nurses, Respiratory therapists, care managers and Physical therapists. Intensivists are the one who take care of ICU and the role of the Intensivist is becoming increasingly complex these days. As medicine evolves and life expectancy rises, the variety of patients and diseases presenting to the Intensivist are rapidly increasing. In a recent article Lewis et al, North American emergency physicians defined good research as “any research that enhances our ability to prevent illness or injury, to improve the quality or decrease the cost of care, or to improve the lives of our patients”.

Keywords

Physical health, ICU Management, Emergency Medicine, Jacobs.

Copyright: © 2019 Saranya Nagalingam

Introduction

 An intensive care unit (ICU) is a section of the hospital that provides special care for patients who are critically ill and who can benefit from Intensive Monitoring and proper timely treatment. Patients get round-the-clock care by a well- trained team which includes Intensivists, Specially trained nurses, Respiratory therapists, care managers and Physical therapists. Intensivists are the one who take care of ICU and the role of the Intensivist is becoming increasingly complex these days. As medicine evolves and life expectancy rises, the variety of patients and diseases presenting to the Intensivist are rapidly increasing. In a recent article Lewis et al, North American emergency physicians defined good research as “any research that enhances our ability to prevent illness or injury, to improve the quality or decrease the cost of care, or to improve the lives of our patients” [1].

Constraints faced by Intensivists

 Perpetuating an intensive care unit (ICU) and providing intensive care for all patients who avail from it necessi- tates a high investment in personnel, technology, and material resources within a short time period, and is naturally asso- ciated with costs.

Work load

The role of Doctor as an Intensivist is getting hec- tic, as Intensivists are anticipated to look after many criti- cally ill patients at a same time. The complexity of the care processes involved, and the fluctuation in the number of patients needing intensive care at a specific time and man- aging intensive care resources are very challenging. Despite the availability of highly eminent team of doctors, situations are quite challenging when two or more patients develops hemodynamical instability at the same time.

Lack of Social Life

 Since the Intensivists are working inside ICU complex, most of the times they are not able to maintain a normal social life, like Doctors working in other clinical departments. They work for certain hours in a day despite of weekends or holidays. Unlike other specialities, doctors who are working in Intensive Care Unit

Physical health: “Doctors are waking up as tired as they went to bed and are going to bed incredibly tired”

Inadequacy of Staffs: One of the most important factors that influences the quality of medical service is Inadequacy of Doctor – Patient ratio. It is directly proportional to the extend care received by the patient.

Protracted Working Hours: There is no normal work day with predefined hours or routine - though there may be an established working hour, difficult clinical issues are re- viewed as you and your team apply critical thinking on the challenging problems.

Intensivists are more prone to have Dehydration since they work for longer duration of time compared to other department doctors. At some times, Doctors even forget to take water or food while they are working, which makes them more prone to develop Dehydration and other health issues.

Mental Health

 Most of the patients’ attenders solely presumes “In-tensivists are believed to be Saviour of the patients, which in turn put Intensivists into more work stress when they are aware that the patient is critically ill and the prognosis of the patient is really bad”.

Despite the fact that we all know about anxiety and depres- sion in our patients, we don’t often acknowledge that they can be influenced on doctors as well. Unlike other special- ities, doctors working in Intensive Care Unit deal with life- and-death situations.

The prevalence of depressive symptoms in ICU practi- tioners has received little recent scientific attention. ICU doctors also are thought to be susceptible to “burnout,” a description for work-related distress that combines emo- tional exhaustion, depersonalization (treating people in an unfeeling, impersonal way), and a sense of low personal ac- complishment [2].

Emergency Situation Vs Ethical Considerations

 “How do you balance patient need with their ability to pay, or make decisions about expensive end-of-life care that only delays the inevitable?” It leads in making very tough decisions on a daily basis.

Liability

 Patients must take some efforts to trust the fact that Intensivist and the team of Doctors will act in professional manner and not misuse the authority of his position.

Communication with Patient Attenders

 Every doctor working in Intensive Care Unit are well aware about the affected person/family  consola- tion voicingcare concerns in actual time, in which stakes are high and time is compressed. Long-term-care facilities are required for critically ill patients, but explaining this as- pect to the attendees is really the toughest part for the doc- tors since they expect immediate recovery phase irrespec- tive of the illness. There are some conditions either may die from the illness or if they survive, they have a probability of recovering completely and of going on with your life as if nothing had happened – Explaining this aspect to the at-tenders is really a difficult task since they wanted to know the outcome immediately which could be decided only based on how well the patient responds to the treatment.

Culture of Inculpation

There are wide range of different problems like neurologic, cognitive, psychological, cardiac, pulmonary, re- nal, nutritional, endocrine which are handled with “Team Co-ordination”. Handling Critically ill patients where the mortality rates are highly prevalent, doctors must not blame other doctors. Nowadays, this culture is found to be alarming which might affect the “Team Dynamics” which would in turn reflect on Patient care.

Myths

 Elderly Doctors are the ONLY Experienced Doctors: “A good relationship with the doctor facilitates satis- fying decision-making experiences.Elderly doctors may have knowledge that has been gained by experience, but they cannot just rest on their laurels. They have to keep up with the rapid changes taking place in this technologi- cal world. Simultaneously, the Emerging doctors should put forth efforts to enrich their knowledge from experienced doctors serving in this field.

Dr. Saranya Nagalingam – experienced working in ICU for past 3 years have been observing a wide diversity of situa- tions and would personally feel that “Trust evolving as a re- sponse to a good doctor-patient relationship, and it helped patients to be more relaxed with decisions and led to better adherence with the doctors – Irrespective of the Age of the Doctor”. Hence, do not presume a person’s knowledge with their AGE.

Sedated Ventilated Patients: Attendees’ Difficulties:

 Most of the time attenders are not in a position to understand what’s happening with their loved ones, how much ever a doctor tries to explain them.

Economical Constraints

 Intensive Care are expensive in most of the hos-pitals and cost for treatment are also comparatively high, which puts patient’s family into economic strain and prob- ably discontinuing treatment at Intensive care units. In few cases, even if the family members are very sure that the pa- tient’s health is improving, there were not able to continue further management due to financial restraints.

Communication with Doctors: “Lack of care coordina- tion and communication can not only cause frustra- tion and confusion for attendee’s regarding the patient Health condition.”Fostering comfort for patients and families to voice con- cerns is central to patient-centred care [3], including under- standing the risks and benefits of care and participating in shared decision-making and informed consent. In addition, speaking up about care concerns may contribute to patient safety as part of an overall safety culture [4].

Educational and logistical mechanisms to help patients and families voice concerns should emphasise that safety issues are vital, even if clinicians appear busy. Education programmes that instruct family members on how to as- sist with the care of critically ill patients can underscore the unique knowledge held by families, the importance of speaking up and the specific mechanisms for doing so, as participating in care can foster a sense of belonging to the team or may enable discovery of clinically important infor- mation [5].

Pain, Suffering, Psychological Distress:

 Patients travel from one part of the state/City an- other part of to get Quality Health Care leaving their families Their       Stay       in       Hospital/Absenteeism             intheir  Work  Place/Lack  of  Sleep   due   to   anticipat- ed       conversations   with       doctors/Running            around for collecting Medicines for the patient and billings Quality health care is still a great Query for thelow socio-economic status people after commercialisation. Hence, their economical demand and their emotional dis- tress to save their loved ones causes “Mental Agony”.Attenders are found very stressed and worried about the patient prognosis and outcome of the treatment.

Conclusion:

An Intensivist’s work is never done. The need for critical thinking and compassionate patient care is the deli- cate balance that every doctor must face every day. Doctors care for the sickest patients. They inform and support fam- ily members through very difficult times. Their successes are wonderful and failures are emotionally and physically wearing.

References