Patient Care

Special Skills Hospitalists Need for the Intensive Care Unit


Critical-care experts point to three types of competency that are crucial for any hospitalist working within an ICU environment. First, hospitalists need a solid knowledge base of the pharmacology, physiology, and pathophysiology of critical illnesses and conditions such as renal failure, respiratory failure, cardiac failure, sepsis, and seizures.

Second, providers need to acquire an array of psychomotor and interpersonal skills. Core skills like endotracheal intubation, chest-tube placement, and arterial and central venous catheterization are essential. But so are broader abilities like bringing people together to work as a team, says Timothy Buchman, PhD, MD, director of Emory University’s Center for Critical Care in Atlanta.

Eric Siegal, MD, SFHM, director of critical care medicine at Aurora St Luke’s Medical Center in Milwaukee, concurs. Much of the value of intensivists, he says, comes from their ability to understand the ICU as a multidisciplinary, team-based environment that emphasizes system improvement, quality control, and consistent patient care.

“Does that sound familiar? It’s what hospitalists do,” he says. “So the conceptual structure of a high-functioning intensivist team is nearly identical to the conceptual structure of a high-functioning hospitalist team; it’s just located in a smaller area, with a higher acuity patient population.”

Dr. Siegal emphasizes the importance of inpatient procedural skills, which he says are no longer emphasized in internal-medicine training. “The good news is, those skills are definable, are fairly easily taught, and are simply a matter of repetition,” he says.

Finally, hospitalists need to adopt the right attitude about what care is or isn’t possible for critically-ill patients, and how families can be integrated into complex, culturally-sensitive decision-making about difficult topics such as organ donation.

“That’s very different when the patient is unable to speak for him or herself,” Dr. Buchman says. “There’s a list of what I would call attitudinal competencies, which is longer than I think most people understand it to be to be an effective clinician. … Although all of them, to some degree, overlap with experience during residency training, they are often at a complexity level that can only be mastered through additional training.”

Bryn Nelson is a freelance medical writer in Seattle.

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