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As the MICU Grows, So Do Other Services for Critically Ill Patients

Mehrnaz Pajoumand, PharmD, (left) clinical specialist II in critical care, consults with Dr. Carl Shanholtz on dosing. Clinical pharmacists will be on the new floors.

The new Medical Intensive Care Unit (MICU) opening on Weinberg 7 in the University of Maryland Medical Center will be a much-needed update and expansion of a unit that supports nearly every other specialty area of the hospital, says Carl Shanholtz, M.D., medical director of the MICU, the department of respiratory care and the Mobile Practitioner Team. Shanholtz also is associate professor of medicine at the School of Medicine.

For example, the MICU is where patients awaiting transplant are often treated. A type of chemotherapy for kidney cancer patients must be delivered in the MICU. And community hospitals all over the state often refer patients who need a higher level of care than they can provide.

"The size of our current MICU limited not only our growth, but the growth of other services," Dr. Shanholtz said. "The expansion and upgrade of the MICU will accommodate more patient referrals from other hospitals."

Each of the 29 rooms is flexible for either intensive or intermediate care, so that when patients in the MICU improve, they won’t need to be moved to a new room for intermediate care.

Increased Capacity, Increased Staff

The MICU will have two physician teams, and an attending will be on the floor 24 hours a day. The nursing staff will also grow and include nurse practitioners.

"We will triple our staff," says Kerry Sue Mueller, R.N., B.S.N., M.B.A., patient care services manager for the MICU. “We’re recruiting about 50 nurses.”

Instead of one nurse station, there will be several: a large one at each end of the unit, as well as smaller stations placed between every two rooms. Called "decentralized" stations, they put a nurse within several feet of each patient, with a window allowing a clear view of the bed in each room.

These work stations will also hold gloves, gowns and masks, eliminating the need for an isolation cart. The idea is to keep the hallways clear, Mueller says.

With the exception of minor painting and cosmetic work, the current MICU facility hasn’t changed much in 20 years, even though the expertise and knowledge of the staff has grown exponentially, along with advances in research and technology.

Nurses will have more office and meeting space. The professionals who support and consult with the MICU physicians and nurses, such as respiratory, occupational and physical therapists, will have their own work room on the floor. Twin power columns will be on either side of the beds — an important safety feature.

"Unlike with headwalls, the power columns allow 360-degree access to the bed, including the head of the bed," says Mueller, greatly improving patient safety in an emergency.

More Space for Staff—and Family

Doors will be wider and inside the rooms, a small alcove area along the window has space for a few chairs. “The family will be able to sit in the rooms more easily," Mueller says.

Architect Christian Bormann of Perkins+Will says the challenges were to design rooms that could be for different acuity levels and to provide nurses maximum patient visibility.

"We developed decentralized nurse work/charting stations outside patient rooms that provide support space close to patients, which gave them direct visibility of patients."

The collaboration with hospital staff resulted in an article, in the March-April issue of Inside ASHE, a publication of the American Society for Healthcare Engineering.

This page was last updated on: March 26, 2007.

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