Checking the Boxes but Missing the Mark: ICU Rounds
After working in 11 ICUs and training 14 others, I have seen multidisciplinary rounds conducted in many different ways. And I’ve also witnessed how easy it is to check the boxes but still miss the mark. Even in teams that are more progressive with the ABCDEF Bundle who “check the boxes” during ICU rounds, the
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What if we had an expert continually present in the ICU dedicated to caring for the mental and spiritual health of families, patients, and staff in the ICU? How would this impact stress, grief, and trauma in the ICU? How would this kind of support impact patient and family experiences, outcomes, and staff morale and
I stumbled upon Kali’s podcast midway through my anesthesia critical care fellowship in February 2021. At our institution, I got the impression that patients in the ICU either got better on their own or had a prolonged and complicated course to LTAC or death. In her podcast, Kali explained that LTAC was rarely the outcome for patients in the Awake and Walking ICU in Salt Lake City.
Their ICU survivors hardly ever got trached, PEGed, or sent to LTAC, and literally walked out of the hospital in condition as close to their previous health as they could be. Although the concept of using no sedation on ventilated patients was completely foreign to me, it made sense based on what I had read in the literature. I devoured all of the episodes from the beginning, many of them bringing tears and regret for my ignorance, followed by inspiration and hope in later episodes. Listening to her podcast has been one of the most profound experiences in my short, eight-year career in medicine.
After discovering the no sedation, early mobility practice at the Awake and Walking ICU, my focus shifted to bringing it to my own institution. I visited Salt Lake City in March to witness it with my own eyes. Since then, I’ve been in touch closely with Kali and Louise to learn the practical approaches to sedation wean and sedation avoidance for newly intubated patients in the ICU.
Mikita Fuchita, MD
Colorado, USA
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