Questions on asthma get straight

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The growing demand for a limited number of Intensive Care Unit (ICU) beds throughout the GTA became increasingly apparent during the SARS crisis. It also became evident that a high percentage of these beds were being used by patients requiring longer-term ventilation, but had needs that were less acute. As one approach to managing critical care overcrowding, the Ministry of Health and Long-Term Care readily accepted a proposal for the development of an innovative Progressive Weaning Centre (PWC) at Toronto East General Hospital (TEGH).

The design of the PWC, which opened in January 2004 as a three-bed unit, was based on similar programs in the United States and Australia. At the time of inception it was only one of two known programs in Canada. The PWC now consists of six beds, and accepts referrals for admission from ICUs across the GTA. The unit has accepted patients from ten facilities in the GTA and received inquiries about the program from across the province.

Although intensive care units are intended to manage patients in crisis, many ICU patients are relatively stable but need to stay in a critical care setting to be ventilated. Longer-term ventilation may be required due to malnutrition, neuropathies and cardiac, respiratory or other issues. Due to the needs of other more critically ill ICU patients, this unique group of patients often does not receive priority attention or consistency of care. However, when an interdisciplinary approach is applied, with the sole focus on liberation from ventilatory support, many of these patients can be successfully weaned.

The TEGH PWC team consists of a respirologist (rotating week by week), RNs, and dedicated RRT coverage for 16 hours a day, with on-call back-up available overnight. There is part-time coverage by a physiotherapist, an occupational therapist, a dietitian, a pharmacist, a social worker and a member of the pastoral care team. The team focuses on the patient’s unique needs and, in partnership with the patient and family, designs an active rehabilitation plan. The team members come from diverse backgrounds, including acute medical floors, ICU, palliative care, home care and complex continuing care areas. The team draws on this diversity to share their expertise when developing plans of care. The result is a cohesive, highly integrated team with a shared vision for desirable outcomes with patient focused care.

The PWC has been open for just over two years and has admitted a total of 42 patients ranging in age from 31-85 years. Compared to the 50 per cent success rate reported in the literature for similar programs, the PWC at TEGH has discharged 59 per cent of patients free from ventilation. One of these patients was Mr. Gaetano Pocchi. Pocchi was fully ventilated when he came to the PWC from The Scarborough General Hospital but after a 44-day stay, was free from ventilation and ready for transfer to a rehabilitation unit.

“I couldn’t talk for two and a half months and now I am able to speak to my family in Italy,” says Pocchi about his stay in the ICU. “I phoned my sons’ restaurant and ordered a pizza; they couldn’t believe it was me. I appreciate all that this team has done for me.”

On average, the length of stay for patients of the PWC has been 58 days. In total, the program has provided 2969 days of patient care, which represents a savings of 4 ICU beds in the health-care system. When the PWC is consistently operating at full capacity, it will annually result in a total of six ICU beds being saved for more critically ill patients. In addition, with direct costs per patient day in the PWC being approximately 50 per cent of costs in the TEGH ICU, the program also creates considerable cost-savings for the health-care system.

The process for referring patients for admission to the PWC at TEGH is simple. A hospital’s ICU team is required to complete a referral form for patients who they feel meet the PWC admission criteria and would benefit from the service. A team from the PWC TEGH will then visit the patient in the ICU setting within several days of receiving the referral. At the time of the visit, the patient is assessed and he and his family are acquainted with the PWC program and some of the team members. Based on bed availability and patient suitability, the transfer from the ICU setting to the PWC is arranged, with an agreement that patients who are not able to wean later return to their home ICU.

The PWC at Toronto East General Hospital welcomes general inquiries about the program or potential patients for admission. For more information please contact nfre@tegh.on.ca