木瓜直播

In the past 20 years, survival has greatly improved among all-comers with left ventricular assist devices, according to Ulrich Jorde, MD, of Montefiore Medical Center in New York, who argues that survival can be even better with the team approach, "as cliche as this may sound."

Jorde makes a case for the daily "think tank at the bedside" in this exclusive interview with 木瓜直播. Regular gatherings in which cardiac surgeons, intensivists, perfusionists, and nurses briefly review each case allow for intellectual cross-fertilization across disciplines, the heart failure specialist says.

A transcript of his remarks follows:

Over the past 20 years, the field has moved from about 0% survival at one year to approximately 80% survival for all-comers with left ventricular assist devices. The key to improve this even further lies in a team approach. As cliché as this may sound, I mean truly a team approach, where we, at Montefiore, get together as a team on a daily basis at the bedside with the cardiac surgeon, with an intensivist, with a pharmacist, with our nurse coordinators, our perfusionists, and we briefly review each case.

What happens here is [first] -- it's very time saving. There are no more phone calls during the day, and second, the most important aspect of this is an intellectual cross-fertilization among disciplines. Once we have done this for about six to 12 months, each nurse at the bedside and each perfusionist, anybody who was involved, will know how we think, how the cardiologist thinks, how the surgeon thinks, how the intensivists think, and they will help us deliver better information.

The same happens between the physicians. The surgeon knows how I look at a case. The surgeon learns from me. I learn from the surgeon. We know exactly what happens in the operating room. The surgeon will share this with me.

This is usually not shared in detail because such information is usually reserved for one group, i.e., the surgeons or the intensivists. We exchange all this information, which initially is helpful, but the key point is that we're beginning to understand how we think. This is a think tank at the bedside, and you will make less mistakes, you will notice things earlier. While it may not be 100%, your results will definitely improve from where you are and probably quite dramatically.

I think there are two major barriers. No. 1 is ego, where the doctors don't really want to share their thought process in fear of becoming irrelevant, and No. 2 is logistics.

It's very difficult for an entire team to get together on a daily basis. Usually, each member, each consultant, comes at a different time, leaves a note on the chart, and then it's everybody else's job to follow up on this or possibly call. The logistics of getting together is probably the No. 1 barrier, specifically for the surgeon who may be in the operating room, who may have an emergency where it may be difficult to get out of their case.

We still are able to establish this by having a surrogate for the surgeon or for the heart failure specialist that can directly communicate.

What is the usual process? The usual process is the surgical team comes very early -- 6, 7 o'clock -- sees the patient, then goes and does the "real work" in the operating room, and then returns later on in the day. These eight or 10 hours in the intensive care units are not optimally utilized because the standard is that anything of significance needs to be approved by the head cardiac surgeon, which is very appropriate, as he's probably the most knowledgeable person.

We changed this in that we established a true team communication, and we can operate and make changes every two hours without everybody being present. Because after six to 12 months working together like this, we will know how we think and the nursing staff knows that the therapy can be changed by much of the team members.

It is not easy to maintain this. You have to get over your ego, and the logistics are a major challenge. It needs to be recognized that this additional time ultimately saves a lot of time and improves outcomes.

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