Sacred Heart Medical Center has begun staffing its intensive-care unit with certified critical-care specialists, called intensivists, who act as liaisons to other doctors who provide care in those units, and also to patients families.


Kootenai Medical Center, of Coeur dAlene, and Empire Health Services two hospitals here, in differing degrees, already had been staffing their ICUs with intensivists.


Sacred Heart recently launched its intensivists program, which so far includes having two intensivists in its ICU 12 hours a day, seven days a week, says hospital spokeswoman Maureen Goins. Empire has provided on-call intensivists for the ICU units at Deaconess Medical Center and Valley Hospital & Medical Center for years, and KMC started its program more than two years ago.


Normally, physicians come and go throughout the day in the ICU, says Elaine Couture, chief operating officer at Sacred Heart. Its rare that a patient in the ICU has just one health problem, which means many patients there are under the care of multiple health specialists.


An intensivist coordinates the care of each patient and relays information about the health status of patients to their family members, says Couture, who helped design Sacred Hearts program.


Often trained as pulmonologists, surgeons, or anesthesiologists, most intensivists have received an additional two years of training in a critical-care fellowship program, and must pass a test conducted by the American Board of Internal Medicine to become board certified, says Dr. Daniel Coulston, an independent intensivist who works primarily at Deaconess. Theres a shortage of board-certified intensivists in the Spokane area, and nationally, Coulston says.


Sacred Hearts Couture says, The intensivist is the overseer and coordinator of care of every patient in the ICU. They not only compile information recorded by various medical practitioners about each ICU patient, but share that information in laymans terms to family members.


Dave Olson, a registered nurse in Sacred Hearts 20-bed ICU for the past five years, says the new program there is a work in progress, but already is improving patient care. He says nurses in the unit now get their questions answered more quickly by doctors and have a better working relationship with the full-time intensivistswho rotate into the unit for seven-day shiftsthan they have with other physicians and specialists, who come in periodically to see certain patients, then leave.


During the first week of Sacred Hearts program, intensivist Dr. Sam Joseph saved a mans life in the ICU, Olson says.


The patient, who arrived at Sacred Hearts ICU from the Spokane Veterans Affairs Medical Center with a windpipe that was swollen shut, was saved when Joseph performed an emergency tracheotomy quicker than the hospitals emergency room could have set up to perform such a procedure, says Olson.


Im sure if Dr. Joseph hadnt been here, the person would have died, he says. The intensivists are the most experienced critical-care physicians in the hospital. They are the go-to guys.


Sacred Heart contracts with Spokane Respiratory Consultants, a group of five board-certified critical-care doctors, to provide intensivists for its ICU unit.


Joseph, who is one of those five doctors and was trained as a pulmonologist, says a big part of an intensivists job is to provide answers to family members, who can receive information they might see conflicting from the other doctors and surgeons who are caring for their loved one. Conflicts in information often occur because family members dont understand all that the doctors are saying, he says.


The families have a lot of questions, and sometimes I can allay some of their fears. Seeing a lot of tubes hooked up to a patient can be frightening, and I can share with them the likelihood of the patients recovery, says Joseph. Also, we sometimes need the consent of family members to perform certain procedures.


Coulston says another big part of the job is to help family members through the grieving process when injuries or illnesses are extremely serious, debilitating, or ultimately fatal.


Couture says the value of intensivists has been documented at many hospitals around the country.


She cites the example of a large hospital in Louisiana where the average patient stay in an ICU dropped from 4.8 days to 3.9 days when intensivists were introduced full time for 12-hour shiftsand fell further to 2.9 days when intensivists were employed around the clock.


Thats important, says Couture, because the demand for ICU beds is more than we have resources for.


Also, instances of infection in ICUs have been reduced dramatically by the presence of full-time intensivists, who often spot problems before they can lead to infections, Couture says.


KMC-Empire Health


KMC launched its intensivist program more than two years ago when Pulmonary Consultants of North Idaho, of Coeur dAlene, contracted with the hospital to provide its five board-certified intensivists, all of whom were pulmonologists, for the program.


One of those intensivists, Dr. James Osmanski, says the doctors group has at least one intensivist on staff in KMCs ICU daily from 8 a.m. to 5 p.m. While there, he says, the intensivists have no competing responsibilitiesand adds in reality, the days are longer than that.


When not physically at the ICU, at least one of Pulmonary Consultants five intensivists is on call at all times, and is obligated to respond by phone within five minutes of any ICU-related emergency call, and be at a patients bedside within 20 minutes of such a call, Osmanski says.


Jan Moseley, KMCs assistant vice president for nursing, says, One thing we appreciate the most is that the intensivist is the captain-leader of a multidisciplinary team. They bring in intense knowledge about the critical-care environment.


At Empire, Coulston says he and two independent intensivists hes associated with, who work for Northwest Pulmonary, of Spokane, dont work full time in Deaconess and Valley hospitals, but rather are on call 24 hours a day. He says the difference between being on call and on duty is minimized at Deaconess because he normally works within 100 feet of the hospitals ICU, whether hes in his private practice or elsewhere in the hospital, and can respond to emergency calls in about three minutes.


He says hes been a practicing critical-care physician for 24 years, which predates the time the first American Board of Internal Medicine test was given for board certification for intensivists, back in 1987. At the time, he says, doctors such as him who had a minimum of five years of experience in critical-care medicine, merely had to pass the test rather than also receive additional training to become board-certified intensivists.


Sacred Heart plans eventually to expand its intensivist coverage to 24 hours a day, says Goins.


Contact Rocky Wilson at (509) 344-1264 or via e-mail at rockyw@spokanejournal.com.