Patient Care

Multidisciplinary Emergency Critical Care Program

Objective

The main objective of the patient care committee is optimizing the quality of care we deliver to the critically ill patients in the ED. We are in the process of establishing an ED based critical care team, consisting of EMCCM trained physicians and nurses. Once the ED staff completes the initial phase of the treatment, the Emergency Critical Care Team will succeed the resuscitation and ensure ongoing ICU-level care for these patients until they get ICU beds or downgraded to the ward status. In collaboration with the research committee, we will ensure high quality of care by tracking our compliance with national and international guidelines.

Current Projects

Flex-RN Project

In response to an increasing number of admitted ICU patients boarding in the ED, Stanford's ED nursing administration first trialed staffing ICU nurses in the ED on the busiest days of the week in October of 2014. The objective of the trial was to bring ICU nursing expertise to the ED. As that trial was felt to improve the care of ICU boarders, nursing administration formally launched the FLEX RN program in June of 2015. The role of a FLEX nurse is a unique role created at Stanford. These dual ED/ICU specialized nurses are staffed 24/7 and they are primarily responsible for overseeing the care of boarded ICU patients. In the ED at Stanford, FLEX nurses work with the ED nursing team, ED physicians, and the ICU admitting team to ensure that boarded ICU patients receive the same standard of care that they would if physically admitted to an ICU. In addition to their resource and oversight responsibilities for boarded ICU patients, FLEX nurses are available for and attend most stroke codes, STEMIs, severe sepsis alerts, and major traumas in the ED. In fulfilling these responsibilities, FLEX nurses are expected to be leaders in the provision of critical care nursing in the ED. Since starting this program, FLEX nurses have met with nursing administration on a monthly basis and have instituted a bundle of nurse-driven interventions to care for boarded ICU patients in the ED.

For any questions about the FLEX RN team, or if you are interested in joining the team, please contact:
Feliciano Javier, fjavier@stanfordhealthcare.org
ICU experience is a requirement of joining the FLEX RN team.

FLEX-RN Group


Emergency Critical Care Team (ECCT) Pilot

Our current primary project is preparing for the launch of a pilot ED-Critical Care which is scheduled to go live on October 24th. The pilot team is composed of ED FLEX RNs and two EM trained CCM fellows: Sara Crager and Julian Villar. We will provide real-time critical care consults, care for ICU patients boarded in the ED, and contribute to ED flow by providing quicker dispositions for patients.

We will conduct a prospective study during the pilot to evaluate the impact of this team on patient outcomes, ED flow, ICU bed utilization, and quality metrics.

For more details, please contact:
Julian Villar, jvillar@stanford.edu
Chris Cinkowski, ccinkowskirn@gmail.com


Improving patient hand off process between ED and ICU

The aim of this project is to improve patient safety and work flow by instituting a systematic patient-hand-off process between the ED and the ICU by utilizing I-PASS.

Ian Storch, istorch@stanford.edu, R3 member of MECCP, is the leader in this project.

Future Projects

Palliative Care at the ED-ICU Interface

We plan to work with palliative care fellows to develop a process that improves access to palliative care for critically ill patients in the ED.

Contact Person:
Talha Mehmod, mehmood.talha@gmail.com

Contact Information

For additional details, project ideas or if you would like to be involved in patient care committee, please contact: 
Chris Cinkowski, ccinkowskirn@gmail.com
Julian Villar, jvillar@stanford.edu

Vision

To push the boundaries of excellence in the care of critically ill patients in the emergency department through the formation of an expert multi-disciplinary team and the creation of a dedicated ED-based critical care unit.

Patient Care Committee Chairs

Julian Villar, MD, MPH
Chief Fellow, EMCCM


Christopher Cinkowski
RN, CEN, CPEN, CCRN