Two years ago, Samuel I. Hammerman, MD, MMM, CPE, FCCP, sat in the front row of the main ballroom to hear the year’s incoming president, J. Christopher Farmer, MD, FCCM, give his address during the Society of Critical Care Medicine’s (SCCM) 43rd Critical Care Congress.
“I remember Dr. Farmer talking about critical care without walls and about developing critical care beyond the boundaries of the traditional intensive care unit,” remembered Dr. Hammerman. “He talked a lot about what post-ICU care will look like and challenged us to think about the chronically critically ill. That really sparked my interest.”
A year earlier, Dr. Hammerman started with Select Medical, one of the nation’s largest providers of post-acute inpatient and outpatient specialized care. He serves as senior vice-president and chief medical officer for the LTACH (long-term acute care hospital) division. Along with dedicated nursing and quality corporate, regional and local leaders, he facilitates best clinical practices in a division comprising more than 100 hospitals throughout the United States. These hospitals routinely treat patients who have a wide range of critical illnesses and injuries, including traumatic brain injury, spinal cord injury, complex infection, and prolonged mechanical ventilation, to name a few.
With the assistance of these dedicated clinical teams, hospital-acquired conditions have decreased, and additional innovations in pursuit of quality and patient safety at the bedside have been instituted. These include having key members of the clinical staff develop a broadened knowledge base focused on the chronically critically ill patient. Recognizing subtle signs in patient condition that signify deterioration and then intervening saves lives, no matter what the venue. LTACH patients have great potential for such deterioration; impacting care through skill set building in this space has been a priority.
After hearing Dr. Farmer’s presentation, Dr. Hammerman had a new focus and new ideas to bring back to his LTACH colleagues. He had already been in involved with the Society’s Fundamental Critical Care Support (FCCS) program, having run programs at Geisinger Health System as an instructor, course director and now as a consultant. But Dr. Farmer’s inspirational speech made him think of the course in a new light.
His ideas blossomed into one of the most unique and widespread applications of the Society’s FCCS program, which prepares non-intensivists to manage critically ill patients.
The Select Medical team has since gone on to implement FCCS nationwide, training more than 1,300 staff employed at its 100 locations across 27 states
. The program is offered as a hybrid, with students enrolling in the Director-Led FCCS online program for access to didactic sessions, pre-tests and post-test, while also engaging in hands-on skill stations offered in various Select Medical locations.
“My previous experience in the Geisinger Health System with FCCS implementation led me to believe that expanding a practical skill set to those clinicians at the bedside matters,” Dr. Hammerman said. “LTACHs care for patients requiring similar skill sets and thus understanding the patient priority was easy. Implementation, though, was a bit more complex.”
“We are using the tools that SCCM has developed to apply this concept of critical care without walls. Our goal was to ramp up our ability to take good care of patients, and we’ve achieved that,” he concluded.
“LTACHs take care of very complex patients. In such a diverse and difficult population, recognizing critical illness early is essential for a good outcome,” noted SCCM President Todd Dorman, MD, FCCM. “I believe it is a very visionary step that Dr. Hammerman and Select Medical have taken to improve the care of their patients through the education of their teams. We all should applaud such efforts that can make such a difference on the front lines of patient care.”
A Nationwide Effort to Bring FCCS to the Post-Acute Setting
Dr. Hammerman approached SCCM with a plan to implement FCCS nationwide and offer it to key clinical staff at each of Select’s LTAC hospitals. Each site was encouraged to bring a core group of staff, with a focus on respiratory therapy, nursing and advanced practice nurses.
The sites ramped up in 2015 by training a large group of staff. The program has continued into 2016, allowing sites to maintain a core group of FCCS-trained clinicians who can use the skills they learn in the course to recognize and manage changes in patients’ conditions.
“Much of our success is having a strong course coordinator,” said Dr. Hammerman. That strong course coordinator is Tessa Terwilliger.
Ms. Terwilliger explains, “Since our organization is located in many different states, the role of course coordinator for a project this large took on new dimensions. In 2015, we offered 103 sessions in 26 different locations that were regionally centric for our registered staff. Coordinating the courses involved several aspects, including participant registration, ensuring delivery of course materials, arranging course location, equipment and on-site resources, monitoring and tracking online course progress and completion, facilitating live session schedules, submitting course forms and coordinating with SCCM to deliver the certificates of completion to each participant. Staying organized and being accessible to directors, learners and local leadership, and working closely with the support staff at SCCM were important strategies to ensure a smooth, user-friendly experience for our staff.
We knew the FCCS program was going to be instrumental for continued development of critical thinking skills and to improve our ability to care for high-acuity patients in the post-acute setting. However, working through the logistics of bringing this valuable course to our staff across so many states and facilities, the task was an initially daunting, but achievable, feat. I was continually surprised at the dedication of my course consultant, our course directors and local facility leadership who again and again found ways to resolve challenges and ensure that our staff was able to benefit from this essential education,” Terwilliger concluded.
Select Medical’s staff resoundingly offered positive feedback on the benefits of learning the basics of critical care. Some of the course evaluation comments sound like this:
• “Wonderful presentation, easy to understand, great instructors.”
• “This program is excellent; helps us to identify how each discipline can be involved and help each other.”
• “I appreciated having nursing and respiratory therapy together collaborating; critical thinking and teamwork in attaining full patient care.”
• “I will collaborate more effectively with the respiratory therapists and do a more thorough assessment when problems or changes in condition arise.”
• “I loved the stress-free learning environment.”
Dr. Hammerman knows his success should not exist in a bubble, so he is working to spread the word about FCCS and its unique uses. In addition to developing an abstract for the upcoming Critical Care Congress, he is presenting his work at his local SCCM chapter and collaborates with regional and national leaders from the SCCM community.
“Bringing FCCS to clinical communities of bedside providers in our hospitals can be a real logistical challenge, from completion of modules, to making certain there are enough quiet rooms for skills station presentations,” Dr. Hammerman said. “The key to success of the program is both clinical and administrative support. Our administrative leaders are fully engaged and supportive of providing the tools necessary for optimal care at the bedside. That’s why the program has been so successful.”