Building a Team of Teams

IHVI's Critical Care Team IHVI’s 48-bed intensive care unit, divided equally between cardiac ICU (CICU) and cardiovascular ICU (CVICU), serves some of the region’s sickest patients. Over the last three years, IHVI’s critical care team has expanded its scope to meet the needs of the region, and its case-mix index has increased 3 to 3.5 times during that period. Over the last 18 months, in addition to caring for critically ill cardiac patients, the teams in CICU and CVICU have risen to the challenge of providing advanced life support for patients who are critically ill with COVID-19. The CICU and CVICU teams have seen commensurate improvements in outcomes even as their scope of practice has expanded. Central to the team's success is the evolution of a "team of teams" model with cross-unit collaboration focused on optimizing structures, systems, staffing and training to deliver critical care effectively to this patient population. At Inova, cardiologists and intensivists co-manage patients with a truly integrated model incorporating cardiac fellows and APPs as well as physical therapists, pharmacists, case managers and many others to take care of the sickest and most vulnerable patients with cardiac critical illness. Cross-disciplinary education and quality initiatives, including the monthly Morbidity Mortality Improvement conference, among many other efforts, is another key aspect of the team’s success. Inova continues to develop as a health system relentlessly focused on continuous improvement. "The learning health system model of care delivery has led us to implement changes that have allowed us to avert challenges down the road." – Shashank Sinha, MD, Co-Medical Director of IHVI’s CICU The team measures success using both process and outcome metrics to ensure best practices and standardized protocols are hard wired to support the best outcomes year in and year out. "Cross-disciplinary collaboration is the cornerstone of the work we do at IHVI," said intensivist Hala Moukhachen, MD, FCCP, Co-Medical Director of IHVI’s CICU and Medical Director of Medical Critical Care Services. “Patients benefit from multiple perspectives, which is especially important for fragile and medically complex patients who need critical care.” Case Study: A Young Patient with Cardiogenic Shock The CICU and CVICU teams worked together to care for a 37-year-old mother with a history of dilated cardiomyopathy and AFib who was transferred to IHVI for treatment of cardiogenic shock. The cardiogenic shock team was activated to evaluate her condition and determine the best path forward. Following a multidisciplinary conference and hemodynamic assessment, the team determined that the patient would need the highest level of life support, venoarterial ECMO. Additionally, she was supported on the ventilator with vasopressors and an Impella device. Throughout her stay, the multidisciplinary cardiogenic shock team collaborated to formulate and enact a treatment plan to offer the best chance of the best outcome. Ultimately, she was successfully removed from ECMO support and was able to leave the hospital on medications for heart failure, returning home to her family. Inova’s nationally recognized approach to the management of cardiogenic shock combined with the multidisciplinary collaboration in the CICU and CVICU provided a coordinated effort to ensure this and many other critically ill patients’ survival.