|
Palmetto Health Richland is the
primary teaching site for this fellowship. It has state of
the art facilities for pulmonary laboratory, bronchoscopy,
common pulmonary procedures, and critical care. The
Pulmonary/Critical Care Division offices are adjacent to the
Palmetto Richland Heart Hospital in 8 Medical Park. Fellow
continuity clinic will be in this location as well as super
specialty pulmonary clinics in sleep disorders, interstitial
lung disease, sarcoidosis, pulmonary hypertension, asthma,
pulmonary rehabilitation, cough, and pulmonary nodules. The
pulmonary rehabilitation program is based at 8 Medical Park
as well. It is a fully operational modern rehabilitation
program in which the fellows are actively involved.
There are pulmonary function laboratories at the USC
Pulmonology clinic offices, Palmetto Health Richland and at
the WJB Dorn VA Medical Center. The fellow will be trained
in all advanced techniques of pulmonary function testing
including methacholine challenge testing and cardiopulmonary
stress testing.
A new service with
Interventional Pulmonology
has been initiated at Palmetto Richland Hospital. This
includes bronchoscopy with photocoagulation, laser
procedures, stints, ultra sound bronchoscopy, and soon to
come, medical pleuroscopy.
A weekly continuity clinic is required and is at the
University Pulmonology offices. Two months of outpatient
niche clinics are included in the rotations.
ICU CARE:
The most critically ill patients
are admitted to the 12-bed Medical Intensive Care Unit at
Palmetto Health Richland Hospital. Typical patients in the
MICU include those with intracerebral hemorrhage, severe
infections, respiratory failure, shock, gastrointestinal
hemorrhage, status asthmaticus, and status epilepticus. In
the MICU, the most advanced technologies available are
employed to reverse organ system failure. This includes both
conventional and advanced modes of mechanical ventilation,
continuous renal replacement therapy, therapeutic
hypothermia, and invasive hemodynamic monitoring. In
addition, multicenter clinical trials and other clinical
research projects are a part of patient care in the MICU.
Recently, we have been involved with trials exploring new
treatments for septic shock and prevention of
ventilator-associated pneumonia.
Nursing-to-patient ratios are 1:2 at most and there is a
dedicated respiratory therapist assigned to the MICU. The
physician team consists of an attending physician who has
received fellowship training in Critical Care Medicine, a
Pulmonary Medicine fellow, three upper-level residents (from
both Internal Medicine and Emergency Medicine), and two to
three first-year residents from Internal Medicine. One of
the upper-level residents is always in the hospital, and the
attending physician and fellow are available by phone for
any questions 24 hours a day.
Multidisciplinary rounds take place every day in the MICU.
The physician team is joined by the Critical Care
pharmacist, MICU charge nurse, patient’s nurse, respiratory
therapist, and case manager. Each patient is seen and a care
plan for the day is created. Progress is monitored by the
use of daily goal sheets which are kept in each patient’s
room.
ICU TEACHING:
Palmetto Health Richland Hospital is a teaching hospital
affiliated with the University of South Carolina School of
Medicine. The physicians in our division all have a faculty
appointment with the University and are dedicated to
teaching fellows, residents, and medical students. Didactic
teaching sessions covering key topics in Critical Care
Medicine take place each morning and are led by the
attending physician. Residents and students may also present
lectures during the rotation. Of course, the most effective
teaching occurs during multidisciplinary rounds. The patient
is examined, various issues related to his care are
discussed, and residents and students have the opportunity
to learn from the attending, the experienced nursing staff,
the Critical Care Pharmacist, and from each other.
NEUROCRITICAL CARE:
Acutely brain-injured patients are admitted to the Medical
Intensive Care Unit and are cared for by the MICU team as
well as the consulting neurologists and/or neurosurgeons. We
focus on providing state-of-the-art care for patients with
stroke, brain hemorrhage, aneurysms, brain tumors, and other
neurologic injuries and illnesses. Continuous EEG
monitoring, intracranial pressure monitoring, and
therapeutic hypothermia are all performed routinely in the
MICU. Currently, Palmetto Health Richland Hospital, working
with the University of South Carolina, is committed to
becoming recognized as a Comprehensive Stroke Center and a
Regional Center of Excellence for stroke care. Multicenter
clinical trials exploring new treatments for brain injuries
are a part of the neurocritical care program at Palmetto
Health Richland.
ICU OUTCOMES:
Once a month, the physicians and nurses meet to discuss
mortality, safety issues, “near-misses,” and other quality
issues related to patient care in the MICU. Projects
addressing these concerns have resulted in shorter lengths
of stay, shorter times on the ventilator, and better
outcomes. We see this as an integral part of our efforts to
keep our patients as safe as possible.
|
