Physicians from two hospitals raise the quality of intensive care

UVM Medical Center and Central Vermont Medical Center physicians build better intensive care in Berlin

When physicians from UVM Medical Center’s intensive care units (ICUs) started working with hospitalists from The University of Vermont Health Network – Central Vermont Medical Center (CVMC) in 2014, the effort didn’t get very far.

There were good reasons to have tried. “We had a well-rounded medical staff, including hospitalists like myself working 24/7, but we didn’t have the volume of critically ill patients to sustain an around-the-clock critical care intensivist team,” says Scott Nelson, MD, CVMC’s ICU medical director.

Their intent – to use video conferencing with intensivists at UVM Medical Center to improve care for critically ill patients in the Davis Special Care Unit at CVMC – was good, but it was not the answer. “We realized we needed a fundamental relationship in person,” Nelson says.

“So, Scotty and I went back to the drawing board,” says Gilman Allen, MD, medical director of Adult Critical Care at UVM Medical Center.

UVM Medical Center intensivists Allen, Ryan Clouser, DO and Joshua Farkas, MD rotated through CVMC on Tuesdays to attend ICU rounds, meet patients, provide consults, perform procedures and confer with providers on care issues. “These three physicians took the time to come down here and get to know us,” Nelson says. “This was key to getting buy-in from our hospitalists – respecting our opinions, being flexible.”

“You need to spend the time there to understand each other’s perspectives and culture, to be a collaborator and a partner,” says Allen. “And you need an on-site champion to make network initiatives work at the hospital level. Scotty has been the perfect person to do that.”

Their ultimate success illustrates the value of stepping outside of comfort zones. “It’s not in our DNA or our training to work like this,” continues Allen. “It’s been a real learning experience.”

CVMC hospitalists no longer need to rely on on-site support. Instead, every weekday, the ICU attending hospitalist works with a medical center intensivist via phone to manage care for critically ill patients. The group is also working to improve quality, developing new order sets and policies. UVM Medical Center intensivists participate in CVMC’s monthly Critical Care Committee.

In May, the team was recognized with the Better Together award – a UVM Health Network honor bestowed on cross-network teams that work together to provide exceptional care.

Mark Depman, MD, CVMC Practice Division leader, summarizes the program’s success: “Across our network, the goal is to provide patients with the same high-quality care everywhere they go. This ICU initiative is one of the first seeds planted in that spirit, and it demonstrates the power of colleagues from across the network working together. “