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Medical ICU: Critical Care Medicine

Critical Care at Jefferson University Hospital has attained pivotal importance and the institution has recently invested over $140 million and upgraded and added 50 additional ICU beds to bring the total to 116, of which 25 are medical critical care. In addition to medical ICU, there is exceptional depth in neurocritical care, cardiac critical care, and trauma surgical critical care. There is a recognition that our tertiary referral patients are sicker, more complex interventions are being performed, and state-of-the-art critical care is necessary for optimal patient care, training of housestaff, and represents a fertile environment for research. 

ICU

The Division runs two independent medical critical care services in Center City campus: the Medical Intensive Care Unit (MICU) team 1, which is a complement of 17 ICU beds covered by 4 interns, 2 residents, one fellow, and one intensivist attending;  and a MICU team 2, which is a novel 8-bed unit covered by critical care nurse practitioners, a fellow, and one attending; the latter also performs critical care consultations in other ICUs as well. The group also provides coverage at the Methodist Hospital campus in South Philadelphia (2 miles from Center City) for a 12 bed MICU staffed by Jefferson residents, fellows, and attendings.

There is daily multi-disciplinary bedside rounding (which includes patient families, pharmacist, respiratory therapist, bedside nurse, and nutritionist) on all patients 7 days per week with a housestaff or NP team, a fellow, and an attending. Fellows supervise the house staff in their initial patient evaluations and, with division faculty, guide diagnostic and therapeutic management. Fellows are in the hospital overnight by a "night float model" and are off all duty the next day. All invasive procedures performed in the MICU are supervised by faculty and fellows, ensuring an opportunity for proficiency in pulmonary artery catheter insertion, arterial cannulation, central venous catheter placement, chest tubes, percutaneous tracheostomy, and bronchoscopy. A diverse patient population offers a wide array of critical care problems, with extensive exposure to patients with shock, ARDS, acute respiratory failure, acute renal failure, coma, metabolic and endocrine problems, infectious disease, hematological problems (sickel cell crisis, TTP, hemophagocytic syndrome), disorders of the gastrointestinal system (acute GI bleeding and liver failure) and others.  As a tertiary hospital, there is extensive exposure to various organ transplants, cutting edge multi-organ interventions including LVADs, ECMO, diaphragm pacing, hypothermia protocol, and MARS.  Most importantly, there is ready access to world class consultants from all disciplines.

The MICU is equipped with state-of-the-art monitoring and support capabilities, including conventional and advanced modes of ventilation (APRV, IRV), ; pulse contour analyses, PICCO, transesophageal ultrasound; continuous fiberoptic mixed venous oximetry; and bedside ultrasonography. A team of specially trained respiratory therapists (under the direction of the Division of Pulmonary Medicine) provides extensive physiologic monitoring and recording services. Personnel from pharmacy, nutrition, nursing and other areas are also involved in a multi-disciplinary approach to critical care. 

The MICU puts a great deal of emphasis on quality and safety initiatives, use of various "bundles", and protocols using state-of-the-art evidence.  There are a variety of committees, educational forums, and M&M to improve quality.  Hand off between providers, daily signouts, and continuity of care in a complex environment are held at a premium. Special emphasis is placed on daily communication with families, empathetic discussions regards end-of-life discussions and medical futility.

Whether you are a patient, a medical provider looking to refer a patient to Jefferson, or looking for additional information on critical illness and intensive care, please click the tabs above to navigate throughout our website.