A hospital's intensive care unit (ICU) is the last place in the world in which you want to find yourself or a loved one. But when one becomes seriously ill, the quality of care they receive in the ICU can mean the difference between life and death.

Only 30 percent of critically ill patients are seen by intensivists, attending physicians with intensive care training and certification. Every year BJC hospitals and other hospitals throughout the state and beyond refer their most difficult cases to Barnes-Jewish Hospital for intensivist-led care in its ICUs. Physicians at other institutions rely on their expertise as partners in their patient's recovery.

The leadership of an intensivist is directly linked to patient outcomes as it reduces mortality and morbidity decreases the average length of stay by one-third, and significantly decreases the cost of care, according to the Society of Critical Care Medicine.

Michael Avidan, MD, is a cardiothoracic anesthesiologist and cardiothoracic intensivist at Barnes-Jewish Hospital and Washington University School of Medicine, where all six of their specialized ICUs are staffed by intensivists.

For Dr. Avidan, a typical day in 56ICU, Barnes-Jewish Hospital's cardiothoracic unit, is long, busy and unpredictable. He begins the day by checking in on patients who may need immediate attention before he goes on morning ICU rounds. It takes three to four hours to visit and attend to 17 beds, typically filled with patients who have had cardiac, vascular or pulmonary surgery.

During ICU rounds, he consults with the multidisciplinary critical care team, which includes residents and fellows from various specialties, pharmacists, nurses, dietitians, physical therapists and respiratory therapists. Each team member contributes to developing goals for the patient each day.

"Our goals may consist of applying interventions that will help make progress such as liberating the patient from mechanical ventilation," Dr. Avidan says. "Working with the acutely ill is so complex that you need input from each team member because they are the ones directly looking after patients."

While advances in critical care medicine have contributed to better outcomes, exceptional care goes beyond reading charts and coordinating medications. Dr. Avidan says that constant bedside contact is also an important part of critical care.

"Sometimes we tend to get so lost in technology that we lose contact with people," he says. "Being physically near patients helps give us an impression on how well they are doing."

After ICU and teaching rounds in the morning, Dr. Avidan spends the afternoon meeting with the patients'' family members. Families are the ones most affected as their loved ones lie unconscious, unaware of the gravity of their own condition. This is where communication from the critical care staff counts the most.

"Family members are vulnerable, confused people who cling to every word we give them," he says. "As they struggle with the uncertainty that their loved ones may live or die, it is our duty to communicate to them with honesty, compassion and respect."

The responsibility of keeping a patient alive can be emotionally draining for the critical care staff. While they have suffered their share of losses, they have also given patients a second chance at life.

"When someone''s teetering on the edge of life and they pull through, it''s the most rewarding feeling," Dr. Avidan says. "That''s one of the things that keeps me motivated day in and day out."

From BJC Today, May 15, 2006, by Nikki Llorin