Caring for the chronically critically ill patient: establishing a wound-
healing program in a respiratory care unit
Miriam Carasa, R.N., Ed.D.*, Magalie Polycarpe, A.N.P.
Respiratory Care Unit, Mount Sinai Hospital, One Gustave Levy Place, New York, New York 10029, USA
Abstract
Chronically critically ill patients may recover from their acute catastrophic illness but still require intensive nursing care. In the
Respiratory Care Unit (RCU) at Mount Sinai Hospital, nurse practitioners, working with nurses and physicians, act as coordinators of care
for these patients. This interdisciplinary collaboration is the basis of the RCU wound healing program and has brought about desirable
patient outcomes. © 2004 Excerpta Medica, Inc. All rights reserved.
Introduction
As a result of advances in intensive care medical tech-
nology, a growing number of patients survive their acute
catastrophic illnesses. Daly et al [1] and Douglas et al [2]
noted that among intensive care unit (ICU) survivors, a
growing number of patients experience unusually prolonged
stays because of complications, comorbidities, and exacer-
bated chronic health conditions. Daly et al [1] described
these patients as chronically critically ill (CCI) and docu-
mented that the ideal place to care for CCI patients is a
low-technology environment with care provided by nurses
using medical protocols. CCI patients still require intensive
nursing care, ventilatory support [3], and close monitoring.
Rudy et al [4] demonstrated that care, collaboratively cre-
ated by physicians and nurses, and managed by nurses
working with medical protocols, could produce excellent
clinical outcomes in CCI patients.
The Respiratory Care Unit (RCU) at Mount Sinai Hos-
pital, New York, provides comprehensive care for CCI
patients. The mission of the RCU program is to wean CCI
patients from mechanical ventilation while caring for all
associated comorbidities. The care of the patients is coor-
dinated and directed by a team of nurse practitioners (NPs).
Through years of experience caring for CCI patients, these
NPs have developed outstanding expertise in providing
quality care to this population. Begonia et al [5] documented
successful patient outcomes related to average length of stay
and weaning; specifically, that Ͼ60% of the patients in the
Mount Sinai Hospital RCU are successfully weaned from
mechanical ventilation. According to the present RCU av-
erage length-of-stay data, average length of stay has de-
creased from 33.3 days in 1995 to 25 days for the first half
of 2001. A successful RCU program mission is based on 2
concepts: the role of the NPs as coordinators of care, and the
collaboration of the NPs, nurses, therapists, and consultant
physicians to achieve the best possible patient outcome.
The care of CCI patients in the RCU is a complex
procedure requiring constant monitoring of their physical
conditions, as well as timely implementation of therapeutic
interventions. A CCI patient in the RCU may have a more
desirable outcome if he or she is alert, hemodynamically
stable, well nourished, and motivated [6,7]. A coordinated
interdisciplinary team approach facilitates the achievement
of the desirable outcome. In the RCU, the NPs coordinate
the efforts of members of a team that includes several
pulmonologists, an endocrinologist, a psychiatrist, and a
surgeon expert in wound healing [5,8]. Some care models
use physicians as coordinators of care [9,10], whereas oth-
ers use nurses [1,4]. In all successful care models, nurses
and physicians working together bring the best outcome to
their patients. Buchanan [11] supports collaborative practice
models because he believes that nursing and medical prac-
tices are complementary. In collaborative models, care pro-
viders use their specific scientific and clinical knowledge to
serve the patients via an effective and efficient team ap-
proach.
* Corresponding author. Tel.: ϩ1-212-241-5365; fax: ϩ1-212-987-
1323.
E-mail address: miriam.carasa@msnyuhealth.org
This work was supported in part by the United Spinal Association.
The American Journal of Surgery 188 (Suppl to July 2004) 18S–21S
0002-9610/04/$ – see front matter © 2004 Excerpta Medica, Inc. All rights reserved.
doi:10.1016/S0002-9610(03)00286-1