What the current critical care team looks like, and how it could be bettered.
Critical care is a multifaceted practice which relies on strong communication and knowledge in sub-specialties. If there’s ever an important time for cardiologists to develop such skills, it’s in managing patients admitted through critical care.
In an interview with MD Magazine®, Venu Menon, MD, of the Critical Care Center at the Cleveland Clinic, explained what challenges currently persist in critical cardiovascular care, how specialties work together in the department, and what the impact is on patients.
MD Mag: In what areas of critical cardiovascular care do we still need to improve?
Menon: Well, I think there are a number of things in the cardiac intensive care unit that really are in evolution. One is, what is the ideal work force. We have a fantastic bunch of traditional cardiologists who've run those units fantastically well over the last few decades, but now I think we need new people with new intensive skills.
So, how do we train these folks? Where do they train? How long should their training be? What should that curriculum actually look like? How much of intensive care, in addition to cardiology, should a fellow who wants to be in this area need to master? These are all questions that we really haven't tackled.
The other important question is, is the ICU open—which means that many physicians admit their patients, and continue to take care of the daily progress of these patients, versus is the ICU closed—where it's run by a cardiac intensivist who then reports and manages these patients completely independently of the primary referral.
These are all things in evolution that the field is going to have to grapple with in the years to come.
MD Mag: How does it directly affect patients right now?
Menon: Patients continue to be treated extraordinarily well. When they come into an ICU today, they often have comorbidities that actually involve us calling up pulmonary colleagues or our nephrology colleagues.
I just think that having these intensive care skills makes one look at the ventilator, look at renal replacement therapy, look at sepsis in a slightly different way. And I think that's where the specialization has a key role.
I think we'll still continue to need and have to work with other colleagues in medicine, surgery, and sub-specialties of cardiology to give the best outcomes to our patients, but I just think having a person in the center of it who can actually be a master conductor of this is really the call for the day.