Thank you for joining us.
This short video is part of our Master Teacher Series and features Dr. David Wessel.
In the following video, Dr. Wessel discusses the origins and development of the field of
pediatric cardiac intensive care.
David, finally, are there organizational changes in how intensive care units, in particular
pediatric cardiac intensive care units, are functioning that give you hope or give you
pause?
Well, I think there are several things that make us hopeful.
First of all, the integration of biology and science into the clinical care aspects, I
think provides a lot of hope that we're going to be able to develop new solutions and new
therapies for cures.
So understanding the biology is really what provides the basis for innovation and new
care.
And we've seen much more integration of the clinical and the scientific side in cardiac
intensive care units around the world.
The other practical care delivery models that have changed, and I think I've been enormously
helpful, is the introduction of specialized nurse practitioners into the cardiac intensive
care unit.
They're so incredibly helpful in getting the work done, paying attention to families, looking
at some of the detail, having a very obsessive-compulsive aspect to the work that they do that's so
important to patient care, especially for complex patients.
One of the organizational changes that I found very useful in my practice has been meeting
together every single morning in a media room to do a 30 minute check of all the patients
with all of the right parties that are there.
The cardiac surgeons are there, the cardiologists are there, the cardiac ICU people are there.
There's nursing representation, and we go quickly through every patient so that we're
all on the same page.
And then the team that makes rounds at the bedside goes out, and of course, then spends
much longer at the bedside looking after those patients.
So the teamwork aspect of this is really very important.
I think it's also going to be important for us to develop the next generation of leaders
that can really bring us to the next level.
It's important to our organizations from succession planning that we have people there who actually
take the field to a higher plane.
I was reminded-- when I first got into cardiology and critical care, I still did a clinic for
cardiology patients.
And in my clinic was Dr. Barry Keane and Dr. Alexander Nadas, one of the pioneers of pediatric
cardiology.
And I was an intensivist, Jeff, and going to clinic just wasn't really my end all and
be all.
And so after seeing one or two patients, I would tell Dr. Nadas that even as a junior
faculty person, I needed to get back to the intensive care unit.
They really needed me and I'd be on the phone and I'd have to go back.
And Dr. Nadas was a little bit famous for this quote, but he used it on me appropriately
more than once.
He told me to be reminded that graveyards are full of indispensable people.
And I understood that to mean that there were people back there in the ICU that really knew
how to do their work without me.
If I didn't have that program there, then I wasn't doing my job right.
And so I think it really is important that we develop these models for the next generation
to provide a level of care that will sustain the field and take it into new frontiers.
And Dave, what gives you pause about some of the organizational changes we're seeing?
Well, one of the things that concerns me, Jeff, as we develop care protocols for more
complex patients, our ICUs are getting bigger.
We have more than one team, there will be two teams.
We stay in-house as attending physicians all night now, and so that means that we do more
handoffs.
We have many more people involved in the care of the patient.
And sometimes the care itself, and certainly, parents' perception of the care is that we
don't know who's in charge.
So I worry a lot about our communication with parents and increasingly, I find parents coming
to me and saying, I don't really know who my ICU doctor is.
I don't know his or her name, and I'm not sure which one.
There are so many doctors.
So I think that's a challenge to us in the field to try to figure out how to optimize
communication with parents, how to keep one attending more connected with the family,
especially a family that's going to be there on longer terms.
I just want to challenge us to try to figure out a better model of communication with the
families, referring physicians, and others, and not to develop a shift mentality to the
field of intensive care.
Thank you for viewing this case reflection on the origins and development of the field
of pediatric cardiac intensive care.
If you would like to see additional cases described by Dr. Wessel, please see them on
the OPENPediatrics website.