Memorial Sloan Kettering was one of the first US hospitals to have an Intensive Care Unit (ICU) dedicated to the care of cancer patients with severe illnesses. The Critical Care Medicine (CCM) Service has provided state-of-the-art multidisciplinary care to critically ill medical and surgical patients both in the ICU and throughout Memorial Hospital via our consultation and Rapid Response Team (RRT) services. We are committed to the education of critical care fellows and residents as one of our core principles. Over the years, we have developed an innovative advanced practitioner (nurse practitioner [NP] and physician assistant [PA]) ICU team, which has grown from providing care in our ICU to pioneering our highly effective RRT.
Our 18,000-square-foot, ultramodern 20-bed adult “closed” medical-surgical ICU — the recipient of the 2009 ICU Design Citation Award from the Society of Critical Care Medicine — was built to take advantage of innovative principles of ICU design. With its ergonomic floor construction, e-glass windows that provide patient privacy, equipment booms, smart alarms, video imagery displays, warm colors, mobile computer workstations and translator carts, and web-based monitoring of all patients and vital technologies via an in-house telemedicine system, the ICU promotes a healing environment, efficient workflow, and ease of patient care.
The ICU divided into three pods that are furnished with all the tools necessary to provide the excellent care that is the standard at MSK. Our state-of-the-art equipment — all tracked through the real-time locating system — includes bronchoscopy carts, point-of-care laboratory testing and ultrasound machines, portable ventilators, advanced airway devices, minimally invasive hemodynamic monitors, transvenous and transcutaneous pacemakers, transcutaneous CO2 and methemoglobin monitors, abdominal pressure systems, bladder scanners, therapeutic hypothermia systems, and fluid warmers. A satellite pharmacy, multipurpose conference room, on-call suite, and two staff lounges are also located within the ICU. Across the main ICU entrance is a large family waiting area and consultation room with private family cubicles, computer stations with Internet access, seating areas, a consultation room with 24/7 video translators, restrooms, and an office for social work staff.
Our critical care fellows, NPs, PAs, residents, and nursing staff provide daily care to patients in the ICU and throughout Memorial Hospital under the direction of a critical care medicine attending physician. Two teams of clinicians, a traditional house-staff team and an advanced-practitioner team, care for patients admitted to the ICU. A third team (consultation/RRT) provides consults and rapid response visits for acutely ill inpatients and outpatients throughout MSK. These services are very active: In 2014, CCM handled approximately 1,000 ICU admissions, 1,400 ICU consults, and 1,000 rapid response calls.
Multidisciplinary care with the patient as the core focus is the cornerstone of our mission. Our ICU was the recipient of the Family-Centered Care Innovation Award (Honorable Mention) in 2014 from the Society of Critical Care Medicine. Daily rounds include the bedside nursing staff, a critical care pharmacist, a nutritionist, a social worker, and a respiratory therapist. Physical and occupational therapists assist in our early mobility program. Social work services are available throughout the evening hours in order to accommodate evening family visitation. Once a week, multidisciplinary rounds take place that focus on ensuring best practices and good communication between clinicians, nurses, infection control specialists, social workers, patient representatives, and chaplains.
Currently our CCM faculty consists of ten intensivists with training and board certification in internal medicine, pulmonary, interventional pulmonary, anesthesiology, and palliative medicine. The CCM fellowship has ten fellows with broad-based internal medicine and emergency medicine training. Anesthesiology residents and medical students are integral to the housestaff team. Our advanced practitioner team includes 25 NPs and PAs as well as NP and PA students from local schools. And our respiratory therapy team includes 55 therapists. Additionally, the CCM Service has a dedicated research nurse and a computer programmer. The bedside nursing team is integral to the care of ICU patients and to our success as a service.
The education of our fellows, nurse practitioners, physician assistants, residents, and medical students is a vital aspect of our service. It is crucial for the growth of our specialty that we train the finest intensivists and advanced practitioners in our field. Our ACGME-approved physician fellowship program, certified by the American Board of Internal Medicine, has been accredited since 1990 and has graduated more than 150 board-certified intensivists, several of whom have become ICU directors. Additionally, we now have a CCM-NP fellowship program as of fall 2015.
A detailed educational curriculum incorporates a core lecture series, visiting professor conferences, fellows’ grand rounds, ventilator and ultrasound workshops, journal clubs, simulation training, weekly board review course, and case review and morbidity and mortality conferences. Fellows and advance practitioners are encouraged to participate in research, present at local and national conferences, and contribute to patient-safety and quality improvement and safety projects.
The CCM Service conducts industry-funded clinical trials in severe sepsis/septic shock, pneumonia, and acute respiratory distress syndrome and collaborative studies with national and international critical care study networks. The CCM Service also performs “homegrown” projects exploring novel biomarkers in the critically ill, outcome studies of chemotherapy and ethics consultations in an oncologic ICU, and patterns of intra-hospital and inter-hospital transports and ICU readmissions. Our faculty includes experts in sepsis, the use and cost of CCM in the United States, ICU design, and point-of-care laboratory testing.