Exemplary, compassionate, and supportive care
In the Department of Critical Care, we make continuous quality improvement efforts by carefully basing our practices on the latest evidence, which means that patients and their families can expect exceptional critical care from highly skilled, compassionate department members.
Quality & Patient Safety
Medical research and evaluation are constantly advancing our knowledge, health care delivery methods and disease prevention techniques, and our patient care must evolve to accommodate these changes.
To this end, we lead a number of projects that continuously improve the care we provide. In 2013-2014, we were able to help 24 per cent more patients than we did in the previous year. We also kept our ICU mortality rates, readmission rates and lengths of stay low. Learn more about our quality efforts.
Clinical expertise, services and programs
We’re proud of our involvement with advanced clinical programs and services that support our commitment to providing exemplary evidence-based care. When coupled with the expertise of our department members, these initiatives ensure that our patients received the best possible care and our students, residents and attending physicians receive excellent education and research opportunities.
Continuous Renal Replacement Therapy (CRRT)
This program ensures our patients receive renal dialysis on a continuous, 24-hour basis, while intermittent dialysis procedures take place over a shorter timeframe—usually two to four hours. This slower, steadier pace more closely resembles the kidney’s normal function over the course of a day.
This is a successful collaboration between the Department of Critical Care and the Division of Nephrology. The Cardiovascular ICU at the Halifax Infirmary is now also able to provide this technique.
Used in conjunction with an assessment of the patient’s entire clinical picture, echocardiography provides information that results in a change in patient management about 25 per cent of the time, making it an extremely valuable tool for an intensivist. It’s safe, non-invasive, easy to learn, and can be done at bedside. In the past few years, this modality has become the standard of care in ICUs and emergency rooms all over the world.
The focused bedside echo uses four key views that allow for easy and reliable trainee education, point-of-care utilization and functionality. We’ve developed a curriculum to ensure our trainees develop a high level of proficiency in the focused ICU echo examination.
Extracorporeal Membrane Oxygenation (ECMO)
This technique - which has seen a resurgence in popularity following the H1N1 pandemic, and in light of safer, more advanced technologies - is one that uses a pump to circulate blood through an artificial lung and back into the bloodstream, providing heart-lung bypass support outside the body.
With improvement in early recognition of the acute respiratory distress syndrome (ARDS), and the earlier implementation of lung protective measures, ECMO is not always required. However,despite its infrequent need/utilization, because of our robust ECMO simulation program and ongoing education in partnership with Cardiovascular ICU and the Perfusion Team, our ICU staff have the skills and expertise required to provide this specific care when needed.
We have had 30 patients be put on ECMO since our program's inception in 2009; our survival rate is 53%, which is similar/slightly better to the global survival rate of 50% as reported by ELSO.
The percutaneous tracheostomy program continues to thrive through use of high-fidelity simulation and surgical-grade cadavers in the Dalhousie Skills Centre. Critical care residents benefit from this high calibre program, as do general surgery, ENT and cardiac surgery residents from across North America. The training has become a model for other centres and we’re now working with industry to develop novel methods and techniques in bedside tracheostomy insertion.
The post-tracheostomy care program now provides multi-disciplinary support for percutaneous tracheostomy after they leave the ICU, and we expect it to decrease time to cannulation as well as in-hospital mortality.
This program creates $3 million in savings across the Nova Scotia Health Authority every year.