A new intensive care unit (ICU) on Braunwald Tower 11C that cares for both medical and surgical patients is helping to address some of the Brigham’s ongoing capacity challenges by adding much-needed ICU beds and greater flexibility to how the hospital uses available resources.
Known as the Medical/Surgical ICU, or Med/Surg ICU for short, the unit opened in September with six ICU beds, and another four beds will open on the unit in winter 2023. It is the Brigham’s first unit to provide intensive care for both medical and surgical patients in the same setting.
“It makes the capacity of our ICUs a little more dynamic,” said Jennifer Beatty, MS, PT, PA-C, director of Clinical Operations and Surgical Physician Assistants. “We will have 10 flexible beds to safely care for critical care patients from either discipline, allowing us to adapt better to the needs of our patients any given day.”
The launch of the new ICU is one of several initiatives the Brigham has undertaken to address unprecedented demand for patient care. It also marks the culmination of a complex, multidisciplinary effort that was a year in the making — including work by several teams to reallocate the space on 11C, prepare the area for a new use, train the clinical teams staffing the unit and safely transport critical care patients between units.
“The high census that we continue to see has been challenging for our entire organization. This effort has been a great collaboration by many different teams that will give us more flexibility in our ICUs,” said Tom Walsh, vice president for Inpatient Operations and Analytics, Planning, Strategy and Improvement.
The unit is novel in its leadership structure, having both a medical director and surgical director in recognition of the value of interdisciplinary expertise.
“There is a huge benefit to having close-knit communication between medicine and surgery,” said Kristin Sonderman, MD, MPH, surgical director of the Med/Surg ICU. “As surgeons, if we call for a medicine consult, it’s because we want to hear from someone who has a different brain. When we’re working side by side, those discussions happen much more frequently. We can easily call over a medicine attending and say, ‘What am I missing?’ or ‘What are your thoughts?’ It’s a true multidisciplinary unit.”
The unit is unique in more ways, too. While other ICUs at the Brigham are staffed by teams that include residents and fellows, these trainees do not make up the Med/Surg ICU team. Instead, physician assistants (PAs), led by Chief PA Caitlin Springer, PA-C, work closely with attending physicians and nurses, led by Nursing Director Hasna Hakim, DNP, MSN, RN, CCRN, to care for patients in this setting.
Rachel Putman, MD, the unit’s medical director, added that combining medicine and surgery has also provided patients and families with greater continuity of care for patients who ultimately require both branches of intensive care.
“We’ve had some very sick medical ICU patients who needed to go to the operating room, and we were able to keep those patients on the same service with the same team,” she explained. “It’s really advancing the collaboration we started building during COVID, when we were all working across different teams and disciplines to care for the same patients.”
In designing the Med/Surg ICU, the planning team gave considerable thought to which patient populations would be most appropriate for the unit, Beatty said.
“There is a wide breadth of patients, including those from general surgery, surgical oncology, ENT, plastics and some emergency surgery,” she said. “We also recognized that there are certain populations, such as neuro or trauma patients, who should continue to go to specialized units for critical care.”
Opening a new unit is far more complex than moving people and equipment to a different floor. Because the hospital has a fixed amount of space for inpatient care, any changes to one area affects another.
In preparation for the Med/Surg ICU opening, the unit that previously occupied 11C, the Thoracic Surgery ICU, was relocated to Shapiro 6E in August. It now shares a floor with the Cardiac Surgery ICU, which occupies Shapiro 6W. Meanwhile, that move triggered another: The previous occupant of Shapiro 6E, the Cardiac Surgery Stepdown Unit, was moved to Shapiro 7W.
For six weeks, nursing leaders for the affected units met regularly to prepare for the safe transport of patients and to ensure staff were welcomed to a space that contained the equipment and supplies they needed.
“Moving any ICU patient is difficult, especially when they are on ECMO and multiple pressors. You need nursing, respiratory, transport and security just to move one patient,” explained Maureen Tapper, MSN, RN, PCCN, nursing director of the Thoracic Surgery ICU. “We met numerous times before the actual move to ensure it went as smoothly and professionally as possible. Everyone did a great job, and I think it’s improved the relationship between nurses on 6 East/West. We both care for some of the sickest patients at the Brigham, so it’s united us.”
Maria Bentain-Melanson, MSN, RN, nursing director of the Cardiac Surgery ICU, emphasized that it was essential to involve unit staff in the planning process, not only to keep them informed but also to solicit their feedback and ideas about how to make the moves successful. For example, nurses shared that they needed a dedicated workroom on the floor for completing nursing reports, which the planning team was able to accommodate.
“With any change, there’s always a fear of the unknown, but including staff in the planning and decision-making from the get-go makes it a more transparent process for everyone,” Bentain-Melanson said. “All of our planning was about how we could keep patients at the center.”