Surgical Critical Care

Washington University acute and critical care surgeons provide 24-hour care of all critically ill patients in a 36-bed Surgical, Burn, Trauma Intensive Care Unit (SICU) at Barnes-Jewish Hospital. These surgeons collaborate with intensivists from the Washington University Department of Anesthesiology and Division of Emergency Medicine. All acute and critical care surgeons hold Certificates of Added Qualifications in Surgical Critical Care awarded by the American Board of Surgery. In addition to providing patient care, these surgeons actively supervise medical students, residents from various specialities, and fellows in critical care rotating in the SICU through multidisciplinary rounds held twice a day. Trainees in the one-year Surgical Critical Care Fellowship are eligible for further certification in critical care.

All acute and critical care surgeons actively participate in a quality assurance program designed to ensure patient safety and improve care of the critically ill surgical patient. This is carried out through a multidisciplinary Outcomes Subcommittee, which includes not only intensivists but also nursing staff, pharmacists, respiratory therapists, dietitians and other providers in the Barnes-Jewish Hospital SICU. This group reviews potential and actual adverse events as well as any issues that may potentially cause problems. Small groups then develop procedures and protocols designed to improve the quality of care; these are implemented by all caregivers in the SICU.

Past efforts include prevention of catheter-related bloodstream infection; optimization of nutritional therapy, glycemic control, electrolyte repletion, discontinuation of mechanical ventilation, and prophylaxis against venous thromboembolic disease; and development of checklists to ensure compliance with standard protocols. Numerous reports of these initiatives have been published in peer-reviewed journals of critical care medicine. Surgical Critical Care faculty members also receive research funding from extramural governmental and private organizations to investigate fundamental mechanisms of critical illness, as well as clinical approaches designed to improve patient outcomes. They are also local and international principal investigators of various industry-sponsored prospective, randomized, multi-center trials evaluating new pharmacological agents and medical devices for critically ill surgical patients.