New Patient Population in CCU

king of codes · Apr 27, 2006

Have lived this too. It seems because of early door to drug/interventional therapy many pt.s are going straight to the cath lab and then to a step down. No more rule outs (maybe if you've a new LBBB). Unless you're in such severe failure, we only see these pt.s on bipap or vents. Low dose nitro and dobutamine and primacor are on tele floors. And many ER's have chest pain centers where they're ruled out there.

seems not much is left but the majority of the aging population with a laundry list of multisystem diagnosis... and then you get overflow. And don't forget my favorite... the 30 day out trached train wrecks from cardiac surgery.

yep, seeing all too often. Our clinical ladder people did get active and started holding inservices on the "new" diagnoses we were starting to see. This helped, kept us learning and not so frustrated. But we still have "remember when..." conversations. It's a different patient population to say the least!

Pinto · May 8, 2006

I agree. Over the last year my critical care dept has merged. I may have a surgical patient in one room and a neoru with an extra ventricular drain next door or a trauma MVC one more down. I like this it gives me more exposure to different patients in critical care requiring different care and needs.

CardioTrans, BSN, RN · Jul 5, 2006

My unit, for now, is a combined CCU/MICU with overflow from Neuro, SICU and occasionally OB/GYN, Oncology. Also, as a matter of fact about a month ago, we had an 8 month old that was in our unit for a liver transplant workup.

We are supposed to be going to a CCU only in the next month, with all the CHF, CAD, MI, LVADs, Heart Transplant workups etc......... plus the primacor, dobutamine gtts that are now on the floor. Who knows.........

Also, have you noticed the patients are getting younger and younger...... Over the last month I think the OLDEST patient I have had was 61.

Critical LPN · Jul 8, 2006

My unit, for now, is a combined CCU/MICU with overflow from Neuro, SICU and occasionally OB/GYN, Oncology. Also, as a matter of fact about a month ago, we had an 8 month old that was in our unit for a liver transplant workup.
We are supposed to be going to a CCU only in the next month, with all the CHF, CAD, MI, LVADs, Heart Transplant workups etc......... plus the primacor, dobutamine gtts that are now on the floor. Who knows.........
Also, have you noticed the patients are getting younger and younger...... Over the last month I think the OLDEST patient I have had was 61.

A nd the morbid obesity is on the rise also with all it's varied complications of infections, wounds that won't heal. Also find every patient has either MRSA, VRE or some other problem that is not always relayed on admission and found out later to the dismay of having to transfer to another room or the risk to staff/patients has already happened. Gee, it looks like Acute Care has become Chronic Care plus!!! Having post MI, Valvular problems, and other Cardiac related surgical patients in some wonderful cases, has become the easy care pt. The patient's with UTI that don't seek help or there physicians tell them to drink more fluids when they call the Dr.'s office and I'll see you tommorrow which by then becomes a raging kidney infection :angryfire on it's way to sepsis. Especially in the diabetic, immune compromised or pregnant pt. who thinks for too many days that her frequentcy is due to the baby sitting on her bladder. Can't tell you how many of those I saw over the years who ended up in full blown sepsis, and had all types of problems to monitor as well as having to be mindful of the pregnacy of which long term Cardiac/Medical ICU nurses are not as normally comfortable with, as most large hospitals have ICU's just for MOMS. However it seems that if they get sick, they get shipped to the other ICU's. Have'nt quite figured that one out. Can anyone tell me why if there are ICUs just for high risk moms, why if they get sick, they come to the CCU/ICUs? I would think that high risk would mean any possible problem and not those associated with just the baby.

Enough ranting I guess, just expect it to get worse as more and more outpatient cardiac procedures are done and insurance won't pay for the complicated post-op elderly or obese patient who has more than one pre surgery problem that leads to what we all know transfers to post-op care problems. We'll see them later after they get sent home too soon and develop the problems that we would have expected and would have been on top of had they stayed another day or two. Welcome to the world of DRGs and Managed Care. Just remember-- nobody is a textboolk case and everyone has at least one or more factors in their life that might just trip up the Managed Care idea. They say to chart the variences and plan for discharge but the insurance companies and Medicare will send them home anyway:madface:

saernurse69 · Jul 10, 2006

Howdy ya'll, Sherry from Texas here....

I am now in ICU, was in ER and this last few months have been OD's, non-compliant diabetics and yep we got the post c-sec mom with hypertensive crises....there is a NICU for the munchkin, however what about the mom's? We have all been fretting about what to do with the pregnant and post and have put together an impromptu inservice for the likes. I seem to have several different types of pt's each shift. Whew, maybe Alzheimers will stay away, I keep learning and get a few new brain wrinkles while I am at it!

Saz4370 · Jul 10, 2006

I totally agree! I work in a very new 8 bed CCU in Adelaide South Australia. We are struggling to fill these beds with acute cardiac patients, mainly due to the fact that we haven't opened our cath lab yet, but also a huge change of culture within the system.

I personally think, that with budget constraints management need to keep the unit full regardless of the patient diagnosis. The ICU in our hospital seems to continually refuse very ill patients stating "they dont fit Intensive Care Criteria".Which by the way changes from day to day (even young very acute patients don't seem to fit the criteria).On further discussions with medical staff, even they seem to be in the dark about who is or is not appropriate for ICU. Our unit it seems is now viewed hospital wide as a pseudo ICU for all of the rejected (and sometimes very sick patients) who aren't remotely Cardiac in origin! It amazes me that this is also happening elsewhere! Yet when we do get the odd very sick cardiac patient, for example with a temporary pacing wire or intra aortic balloon pump, ICU claim these patients as their own, and then borrow our equiptment, our expert advice (some times asking for our RNs to care for the patient) and seeking our cardiologists for input too.

Do you think this is some kind of a game play here? or are there other reasons I am not yet aware of?

Saz x x:uhoh3: :nurse:

Critical LPN · Jul 11, 2006

I totally agree! I work in a very new 8 bed CCU in Adelaide South Australia. We are struggling to fill these beds with acute cardiac patients, mainly due to the fact that we haven't opened our cath lab yet, but also a huge change of culture within the system.
I personally think, that with budget constraints management need to keep the unit full regardless of the patient diagnosis. The ICU in our hospital seems to continually refuse very ill patients stating "they dont fit Intensive Care Criteria".Which by the way changes from day to day (even young very acute patients don't seem to fit the criteria).On further discussions with medical staff, even they seem to be in the dark about who is or is not appropriate for ICU. Our unit it seems is now viewed hospital wide as a pseudo ICU for all of the rejected (and sometimes very sick patients) who aren't remotely Cardiac in origin! It amazes me that this is also happening elsewhere! Yet when we do get the odd very sick cardiac patient, for example with a temporary pacing wire or intra aortic balloon pump, ICU claim these patients as their own, and then borrow our equiptment, our expert advice (some times asking for our RNs to care for the patient) and seeking our cardiologists for input too.
Do you think this is some kind of a game play here? or are there other reasons I am not yet aware of?
Saz x x:uhoh3:

Saz 4370,

Like you, I have found that the consideration of who is "sick enough" to be in any given type of ICU/CCU/MICU/PICU/SICU etc, whatever you call the particular units is a questionable game. I've seen physicians put patient's who belong in one type (and staff better trained for the problem)into another type of Care Unit solely on the reason they like a particular staff or do not want to have to shuffle all over the hospital to see their patients. Thus the " borrowing" of this nurse to float to that unit or the constant calls for advice, help with lines, etc. that can get real tiresome when you have more than just that Dr.'s patient to care for. Also, I realize that bed numbers and assignments are geared to supposedly not swamp one particular unit. However it seems that it would be better to realize the changes in our everchanging client type and numbers and roll it to one large Critical Care Unit that we all could be there to share care ideas, experiences and broad-based knowledge instead of continuing to fool ourselves and to try and recruit staff with the idea that they will be taking care of a certain type client base. I realize also that it would be unfortunate for those who are in higher management postions in a given area to adapt. But we the staff have too!:roll They may just have to " roll with the flow" like we are all asked to do.

We try to specialize to be more valuable to our given area assigned and provide hopefully better cutting edge care, just to be told to "adjust, after all, traveling nurses have to do it and so do floats". That may be true but not every nurse wants to be "broad based". Some actually have been fooled by the system over the years, that specialization is where it is at and to continue to focus and learn a given area to provide better care. Is that not why we have such extra learning incentives as CCRN, ECRN and other programs to add more certifications by our names, or is it just that, more letters behind our names? Sometimes I feel that is how more revenue can be gotten from nurses as many of us have been able to use life experiences to help get through to on-line degrees and have not had to be trapped totally into the large pay out to the colleges to "well round" our education with courses that have mostly nothing to do with our day to day challanges. I remember when you could get the instituions you worked for to pay for just about any inservice or seminar that "was" related to the patient types you cared for. Now, you have to pull teeth and promise all types of inservices back to staff, etc,(not bad idea but grueling) to go to these but if you go back to school to take a gaggle of courses (expensive) that have nothing to do with but must take to get the ones you do need to get a degree, then they will assist. Seems off to me??? I think nursing education, unless you are just wanting to be a business manager, needs to focus to the patient everchanging needs. Also would be refreshing to take courses that focused on current events in nursing and trends.

Perhaps we all have to really get real with this "global" community and economy that we keep hearing from our Wawshington D.C. reps/World leaders, and realize that we are not specializing as we always had to take care of all types and kinds of patients and any short term specialty areas will soon change to something else. Demand a broader education on the current and evolving client community healthcare demands and special needs. We would all be better prepared for what was thrown at us instead of the deceit of thinking we are being hired for what "we want" or think we are getting into as it is always more glamorous to feal like we are in a specialty other than the broad field of Special/Intensive or Critical care .

Don't get me wrong, I've centered my career over cardiac severity, but I also note that all the advances in this field make it less exclusive as is the case with GI,Pulmonary etc., mainly it is just the deviates from the norm that face all specialties that make it intensive care or special care as the patient problem is not one area specific. (Enter the "multi-system failure" patient?) :twocents:

Saz4370 · Jul 12, 2006

You are so right. We as Professionals have been convinced by "the system" to undertake more and more specialised and expensive educational persuits but is this what is currently needed to accomodate our patients more complex needs? Is healthcare as we know it about to evolve and change again? The future will be interesting and exciting for all of us Im quite sure. SAZ X

Geeg · Jul 12, 2006

Hi. I used to work in Cleve, for about 20 yrs.... Pts in the units now, would be dead 10-15 yrs ago, consequently the current floor pts are the ICU pts of 10-15 yrs ago.

Geeg · Jul 12, 2006

Everyone becomes a medical pt in the end. That is, once surgeons can't or won't cut them anymore.