Journal of Intensive and Critical Care Nursing

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Editor Note - Journal of Intensive and Critical Care Nursing (2022) Volume 5, Issue 6

Effective interprofessional collaboration between surgeons and intensivists impacts patients.

Peter J. Klenn*

Department of Medicine, Division of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria

*Corresponding Author:
Peter J. Klenn
Department of Medicine, Division of Internal Medicine
Medical University Innsbruck
Innsbruck, Austria
E-mail:[email protected]

Received: 22-Nov-2022, Manuscript No. AAICCN-22- 84837; Editor assigned: 24-Nov-2022, PreQC No. AAICCN-22- 84837(PQ); Reviewed:02-Dec-2022, QC No. AAICCN-22- 84837; Revised:19-Dec-2022, Manuscript No. AAICCN-22- 84837(R); Published: 21-Dec-2022, DOI: 10.35841/aaiccn-5.6.129

Citation: Klenn PJ. Effective interprofessional collaboration between surgeons and intensivists impacts patients. J Intensive Crit Care Nurs. 2022;5(6):129

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Abstract

Critical care medicine specialists, commonly known as intensivists, are doctors who specialise in the care of patients in an intensive care unit (ICU). Intensivists are doctors who specialise in the care of critically sick patients who direct and provide critical care in an ICU. Intubations, central line placements, arterial line placements, thoracentesis, lumbar punctures, and bronchoscopies are among the operations performed by intensivists. Anesthesiologists may work as intensivists, or critical care doctors, in intensive care units. Hospitalists spend their whole workweek in the hospital; therefore they are conveniently accessible even after hours and on weekends. Our Intensivists are board-certified physicians who provide specialised care in the ICU for critically ill patients. Anesthesiologists earn a lot of money since they are important medical experts before, during, and after surgical procedures. Another reason they earn a lot is that they went through years of expensive college, training, residency, and fellowship.

Keywords

Intensive care units, Emergency care units, Surgeons, Intensivists, Critical care, Patients.

Introduction

Surgical problems, infections, rejection, and acute renal injury are also common. Because organ transplant recipients are so complex, a multidisciplinary team of intensivists, surgeons, pharmacists, and transplant specialists is required. A temporary pacemaker is required following cardiac transplantation until the conduction system recovers. Heart stiffness and elevated cardiac markers indicate rejection. An endomyocardial biopsy is conducted through the right jugular vein, which must be preserved. Early management for aspiration is recommended for lung transplant patients to prevent chronic rejection. The risk of infection is substantial, necessitating diligent surveillance and rigorous treatment, particularly for fungal infections. Because the liver is immunotolerant, it requires less immunosuppression. Massive blood loss and coagulopathy are common complications of transplant surgery. Other risks include portal vein or hepatic artery thrombosis, as well as biliary leakage or stenosis. Kidney transplant recipients are at a significant risk of developing cardiovascular disease, hence post-transplant anaemia should be managed aggressively. Delayed graft function is frequent after postmortal transplantation, and dialysis is maintained. Ultrasound can detect problems of ureteral anastomosis [1].

When a patient is admitted to the intensive care unit, the admitting surgeon is thrust into a new atmosphere. The surgical intensive care unit (SICU) is "closed" in some institutions, with critical care providers managing treatment; in others, the unit is "open," with the admitting surgeon in charge. The "mixed" paradigm of ICU administration is a collaborative approach. This article discusses common issues and disagreements between admitting surgeons and intensivists. It is written from the standpoint of two surgeon-intensivists who have served in both capacities. Recent behavioural and sociological research on ICU conflicts and resolution is reviewed, and new conflict resolution tactics are given [2].

The body of evidence in favour of specialised intensivist personnel in intensive care units is expanding. Despite its clinical and economic benefits, the intensivist approach is hampered by medical staff politics and a shortage of intensivists. The goal of this research is to expose patients to the benefits of intensivists sooner and to establish team care in the critical care unit. The model's implementation is hampered by a lack of intensivists, reimbursement for intensivists, and political will. The model is ideal because of four characteristics: physical presence, critical care practise knowledge, team care coordination, and unit management. It may be beneficial to avoid categorising critical care units as open or closed and instead consider team care, in which hospitals strive to achieve the model's features given their resources and culture [3].

Surgical decisions in advanced cancer patients require significant consideration and contemplation to balance the high risks with the potential palliative benefits. We wanted to evaluate surgical decision-making and palliative care training among surgeons and medical doctors who often treat patients with advanced cancer. We expected that surgeons would have less palliative care training than medical doctors, and that this would be related with more aggressive treatment recommendations in clinical scenarios of advanced cancer patients with symptomatic surgical problems. A 32-item questionnaire addressing palliative care training and four clinical vignettes depicting patients with advanced cancer and symptomatic surgical conditions was distributed to practising surgeons, medical oncologists, intensivists, and palliative care physicians from a large urban city and its surrounding areas. Regardless of physician speciality, there was little agreement on physician recommendations for treatment of the four clinical vignettes. When compared to physicians, the absence of palliative care training was related with a higher frequency of suggesting major surgical intervention [4].

Rather than simply dictating what treatments patients will and will not receive, physicians are required to engage patients as partners in evaluating the potential advantages and hazards associated with treatment alternatives and selecting from among medically appropriate treatment options. This collaborative paradigm recognises that citizens in multicultural countries have diverse values and are likely to hold opposing perspectives on whether the potential advantages of a medical intervention exceed the potential hazards. However, there are times when the collaborative approach fails owing to irreconcilable differences. Cases in which patients are predicted to die if they do not receive a treatment, and either the patients or their surrogates insist on the treatment despite the physician's view that it is unwise to provide it [5].

Conclusion

Intensivists save both lives and money. Hospitals may establish a successful intensivist model by focusing on team care, and patients may reap the benefits of spending less on healthcare and living longer. To implement this paradigm, physician and hospital leaders must collaborate. Significant gaps in palliative care training continue among surgeons, and they are associated with more aggressive treatment recommendations for the selected scenarios given in patients with advanced disease. These findings indicate the need for increased system wide initiatives in palliative care education among surgeons, such as the inclusion of a systematic palliative care training curriculum in graduate and continuing surgical education.

There is a significant difference between surgeons and intensivists-physicians who specialise in the medical management of critically ill patients. We will demonstrate that there are compelling grounds to scrutinise the decisions of both surgeons and intensivists.

References

  1. van den Hoogen MWF, Seghers L, Manintveld OC, et al. Care for the organ transplant recipient on the intensive care unit. J Crit Care. 2021;64:37-44.
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  5. Pronovost PJ, Holzmueller CG, Clattenburg L, et al.Team care: beyond open and closed intensive care units. Curr Opin Crit Care. 2006;12(6):604-8.
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  7. Bateni SB, Canter RJ, Meyers FJ, et al. Palliative care training and decision-making for patients with advanced cancer: A comparison of surgeons and medical physicians. Surgery. 2018;S0039-6060(18):30078-3.
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  9. Wicclair MR, White DB Surgeons, intensivists, and discretion to refuse requested treatments. Hastings Cent Rep. 2014;44(5):33-42.
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