It's 7 a.m. and attending physicians from seven of the 10 intensive-care units at Montefiore Medical Center in Bronx, N.Y., gather for their first daily triage session of the hospital's sickest patients. Residents, fellows, nurses and other specialists ring the conference table. More join in via video feed from ICUs at Montefiore's two remote campuses. Bed by bed, unit by unit, they rapidly run through the multiple complex conditions each patient faces, each word telegraphing just how critical the patients are and how long they are likely to need ICU care. Some patients are improving and heading for a less-intensive step-down unit, opening up some beds. Anywhere in the 1,491-bed hospital, a patient could suddenly suffer respiratory, heart or other organ failure and need critical care. And anything from gunshot wounds to auto accidents to a building collapse could bring more critically ill patients into Montefiore's emergency department. As the triage sessions illustrate, handling the flow of patients in and out of the hospital's 78 adult medical and surgical ICU beds, and anticipating who else might need such high-level care on any given day, requires precision management. Many hospitals struggle to do it effectively, but Montefiore doesn't?thanks to several innovations spearheaded by Vladimir Kvetan, director of critical-care medicine, over the past decade.
