To meet the growing demand for treating critically ill surgical patients, Dr. Sauer and Department Chair Dr. Matthias Eikermann have devised a strategy to expand the step-down unit on the 7th floor at Moses. This unit serves as an intermediary for patients who require additional intensive care prior to being moved to a regular hospital floor. Six new physician assistants will provide step-down unit coverage during evenings, weekends, and holidays for round-the-clock care to the most vulnerable patients. The physician assistants will also work in the SICU and the post-anesthesia care unit (PACU) under Dr. Sauer’s leadership. 

“Hiring the new PAs signifies a real investment from hospital leadership in the Surgical Critical Care program,” Dr. Sauer said. “It’s a huge undertaking and demonstrates that they agree with the need and support what we’re trying to accomplish, which is to improve the quality of care for these patients during their first few post-operative days when they’re at their most vulnerable.” 

In addition to strengthening the Moses Campus step-down unit, Dr. Sauer and his team have been working on quality improvement initiatives that have already led to improved patient outcomes. Dr. Michael Kiytakin, Attending Anesthesiologist and Intensivist, serves as the Director of Quality Improvement for the Division of Critical Care Anesthesiology and works closely with Dr. Sauer to achieve better outcomes for SICU patients.  

The Critical Care Anesthesia quality improvement team recently developed a new ICU QI database, which has been a valuable resource in studying the impact of interventions on patient outcomes. The quality improvement team recently completed a study evaluating outcomes in the SICU from 2019 and 2023 and found improvements in the duration of invasive ventilation, a lower incidence of respiratory failure, and a lower proportion of deep sedation. Specifically, the study showed that since October 2021 – when the Department of Anesthesiology began managing the Moses Campus SICU – patients were mechanically ventilated for 11 hours less on average, had a 38-percent lower risk of acute respiratory failure, and had a 19-percent lower proportion of being moderately or deeply sedated during intermittent mandatory ventilation. 

It is important to reduce deep sedation for patients in the ICU, Dr. Eikermann explained, because it is associated with a higher risk factor for prolonged intubation, respiratory failure, and delirium.  

“We have made great achievements in the quality of care over the past two years,” Dr. Eikermann said. 

In addition, the team has minimized catheter-associated urinary tract infections (CAUTI) and has achieved a one-year zero-percent rate of central line-associated blood stream infection (CLABSI). Dr. Kiyatkin said the goals of the Critical Care Anesthesia quality improvement team are to promote healthy recovery and discharge to home with normal function for patients as well as to boost patient satisfaction. Anesthesiologist intensivists have a wide breadth of skills that make these goals achievable – in collaboration with their multidisciplinary colleagues, Dr. Kiyatkin explained. 

“Anesthesia intensivists are uniquely well-suited to take care of surgical ICU patients,” Dr. Kiyatkin said. “We understand how surgeons think, when to rush and when to move slowly, and how to provide optimal perioperative care. We also have an excellent QI team in the SICU that works closely with our wonderful nurses to continually improve patient outcomes.”