Cardiogenic shock- patient placement

[ownie11]

I work in a Coronary Care Unit, where we have always taken care of the cardiogenic shock patient requiring Impella support or Intra-aortic balloon pump support. Recently, a sShock team has been developed at our hospital. This is a fantastic concept, and especially in our community hospital setting, it guarantees swift attention to the shock patient as well as ongoing support/management of the patient on the device. Before the Shock team, we would sometimes have difficulty reaching attending physicians when the shock pt needed attention. So what is the problem?

Well, the shock team is composed of a cardiac surgeon, a cardiac Interventionalist, a CHF doctor & all their PAs and NPs. So now the cardiac surgeon is calling all the shots and demanding these pts be placed in Cardiac Surgery ICU instead of our CCU. And his demand has been met. The CCU nurses are no longer taking care of the sickest hearts. We've been told if we want to do that, we have to cross-train to CSICU. I think this move was a blow to our CCU nurses in so many ways. We are supposedly a "Beacon" unit, but we had no voice in this decision. There was no discussion with us. Our specialty is sick hearts, CSICU is surgical hearts. I think this is wrong placement of these patients, because of one doctors wish. He does not want to cross the hall to our unit.

Your thoughts?

[MunoRN, RN]

It sounds like you're referring to what I've always known as an MCS team (mechanical circulatory support) which is typically headed up by a cardiac surgeon with MCS credentialing. Where I've worked, impellas, total hearts, etc fall under the cardiac surgery umbrella, while balloon pumps fall under the cardiac interventionists and MCS team. Destination and bridge VADs are initially under the cardiac surgery MCS MD and then transition to the cardiology MCS MD.

I've worked one place where CSICU nurses only did open hearts, and a couple where CCU and CSICU nurses were all cross-trained to each other. Personally I think it makes more sense for CSICU and CCU nurses to be one in the same.