Emergency Information Take Over

UMMC Opens Unique Critical Care Resuscitation Unit

Thursday, August 01, 2013

 James O'Connor, MD

A new Critical Care Resuscitation Unit (CCRU) opened at the R Adams Cowley Shock Trauma Center on July 18, 2013. The CCRU is designed to improve the flow of critical-care patients to appropriate patient care areas at the University of Maryland Medical Center (UMMC). “The CCRU will focus on critically ill patients with advanced surgical specialty needs who are transferred from outside hospitals,” explained Lewis Rubinson, MD, PhD, who is medical director of the new unit.  “Examples of patients include those with acute care surgical or soft tissue problems, cardiothoracic and vascular emergencies, as well as neurological and neurosurgical emergencies.”

Over the course of only a few hours, CCRU patients are evaluated by a nurse practitioner and attending physician, stabilized, and then sent to a bed in an appropriate critical-care unit. These patients come from outside hospitals that are not able to offer the same level of care that is available at UMMC. The CCRU streamlines the process for the referring physician, so with one phone call a patient can be on his/her way to definitive care at UMMC, and “everyone is on the same page about how we’re going to handle this patient,” said James O’Connor, Associate Professor, Department of Surgery and Chief of Critical Care at Shock Trauma. “That’s really important. You want to streamline the process for the referring physician, and yet you want to make sure that the care the CCRU is providing is exactly the care that referring physician wanted for that patient. It will be a collaborative effort here.”

Collaboration in health care will become more and more necessary as the Affordable Care Act and other big changes in medicine start to make an impact. “Regionalization of surgical critical care services is an important aspect of the changing healthcare environment, and the CCRU will assist UMMC in being a regional and national leader in a high quality, systematic approach to regionalization,” said Dr. Rubinson.  “To our knowledge, this novel effort is the first of its kind in the US, and it promises to keep UMMC at the forefront of innovative surgical critical care.”

The staff of the CCRU is comprised of experienced Shock Trauma personnel. “The CCRU will be staffed 24/7 with University of Maryland Shock Trauma Center (STC) and School of Medicine critical-care physicians, who will work collaboratively with nurse practitioners and physician assistants, critical-care nurses, and respiratory therapists,” said Dr. Rubinson. “The CCRU will also benefit from STC pharmacists’ consultation, and utilize the diagnostic and therapeutic resources of STC.”

Eventually the CCRU will be an eight-bed unit, but it will start with four beds and ramp up from there. “This is a brand new unit, a brand new service, and a totally new way of doing business, so we wanted to start a little smaller,” said Dr. O’Connor. Even with just four beds, there will be a constant flow of patients into and out of the unit. “Patients will not receive their definitive care here – they will come and get what resuscitation they need and the appropriate tests, in coordination with the ICU team or other service where the patient might be going for definitive care,” said Dr. O’Connor. Added Dr. Rubinson, “The ideal length of stay will be 6-8 hours, until the patient either goes to the operating room or to a long-term specialty ICU for definitive management (e.g. the surgical ICU).”

As Dr. Rubinson mentioned, this unit will be the first of its kind in the U.S. “There is literature out there about this concept, but to our knowledge, no one has actually operationalized this,” said Dr. O’Connor. “It’s quite exciting.” - Caelie Haines

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