But this same issue arises for other groups as well. Some patients don't really need to be in the ICU and could be successfully cared for elsewhere, if we planned properly. Then there are other patients who could have been treated for a shorter period of time in the ICU if we had appropriate general protocols that applied to them. I think that we need to move to a form of care that's consensual enough so that all physicians can understand what other practitioners should be doing with the patient. We have to make joint decisions about how we run ventilators, how we give antibiotics, how we use hemodynamic monitoring.
Ancillary services can help bring consistency to care.
For example, if a service that tends to sedate patients more often than other services learns from the pharmacy that its practice isn't optimal, it's far less contentious than having a physician from another service nag them. For respiratory therapy, one of the issues determining how long people are in the ICU is how long they are on the mechanical ventilator. If we can make up a protocol for weaning patients from mechanical ventilators, we establish algorithms in really helpful ways. There's much less resistance when the decisions are consensual, when they're discussed in an open forum such as the ICU committee, or when the technical issues are raised by nonphysician members of the health team in their areas of expertise. Nurses have the advantage of not being burdened with having ordered or performed a procedure that fails to rescue the patient.