THE UP-PGH

CENTRAL ADULT AND PEDIATRIC IN TENSIVE CARE UNIT (CENICU):

AN OVERVIEW
JUBERT P. BENEDICTO, MD , FPCP, FPCCP
Pulmonary Critical Care Specialist
Past Head, UP-PGH CENICU
Past Chair, UP-PGH CCU-MAT
University of the Philippines, Manila
ICU Mission
preserve meaningful human life by protecting and sustaining patients in a caring
manner when they are threatened by an acute critical illness or injury
provide specialized rehabilitative care to ICU patients as they start to recover from their
critical illness or injury
provide compassionate and attentive care to the dying and their families
ICU Resource and Organization
The ICU, after the operating room is the most important consumer of resources in the
hospital, per patient and per unit of time.
Intensive Care Med (1991) 17:127-128
As care has become more complex for the critically ill patient, mechanisms to integrate
complex behavior into a functional whole have become increasingly important.
Fink, Textbook of Critical Care, 5th ed. Copyright 2005 Saunders
CENICU: background
Established in 1993- initially, patients were from MICU
has evolved into the present unit consisting of 15 beds (11 pay; 4 charity)
Only area in PGH for critically-ill pay patients
Attempted to have other specialties involved
serve the very sick patient with the same zeal, compassion, and combined with
specialized care using modern technology and updated medical knowledge and skills.
CENICU Vision Statement
The Central Intensive Care Unit of the Philippine General Hospital
see itself as an excellent provider of intensive care for patients with multiorgan dysfunction or
failure
CENICU Mission Statement
We commit ourselves :
To provide quality care with quality speed to critically ill patients while adhering to the policies
and guidelines of the different units of the hospital
QUALITY OBJECTIVES
CUSTOMER/CLIENT SATISFACTION
Attainment of at least 3 or satisfactory rating on the customer/client evaluation.
Reduction of customer complaints by 20% within the 2 nd semester of the year.
COMPLIANCE WITH REGULATORY REQUIREMENTS
Compliance of at least 80% with the requirements set by each governing body.
Quality patient care
Rational staffing complement
Volume statistics
Infection control

 Adverse/sentinel events
Morbidity/mortality rates
Timely delivery of health care

Organizational Structure
Nursing and Paramedical Staf
Supervisor- 1
Charge Nurse -3
Staff Nurses -27
Administrative Officer-1
Nursing Aides- 8
Medical Staf
Attending Physicians (Open ICU): >1/patient
1/patient
ICU Head:
1
Pulmonary Fellow: 1
Medical Resident: 3
Medical Staf
Closed ICU setting: dedicated staff of intensivists man the ICU, and main attending
physician relinquishes service to the ICU consultant/service upon entry of patient to the
ICU
Open ICU setting: Attending physician(s) maintain(s) service even while in the ICU
Baggs Components of Collaborative Practice
cooperation
assertiveness
shared decision-making
communication
joint planning
coordination
Characteristics of Multidisciplinary Approach to ICU Care
co-responsibility of medical and nursing directors
nursing, RT, and pharmacy collaboration with med staff
use of standards, protocols and guidelines
coordination and communication in all aspects
practitioner certification, research, education, ethical issues, and patient advocacy
Implementing Collaborative Practice
administrative function: team organized
define nature of population
skills training and enhancement
controlled access
managerial factors: programming and feedback mechanisms

POLICIES

Criteria for Admission according to priority : Priority 1

Postoperative or acute respiratory failure patients requiring ventilatory support, and
shock or hemodynamically unstable patients receiving invasive monitoring and/or vasoactive
drugs.
Criteria for Admission according to priority : Priority 2
Patients with co-morbid conditions who develop acute severe medical or surgical illness
like diabetes mellitus, hypertension, CAD, chronic renal failure, CVD and liver cirrhosis.
Criteria for Admission according to priority : Priority 3
Patients with metastatic malignancy or CA complicated by infection, airway obstruction or
cardiac tamponade.
Criteria for Admission according to priority : Priority 4
Little or no anticipated benefit from ICU care based on low risk of active intervention
that could not safely be administered in a non-ICU setting
Patients with terminal and irreversible illness facing imminent death (too sick to benefit
from ICU care).
Specific Diseases Needing ICU Admission
Contraindications for Admission:
Grossly infected lesions without cardiopulmonary problem.
Infectious cases such as Meningococcemia, measles, Mumps, Rubella, Adenovirus,
Varicella or Disseminated Zoster, rabies and Influenza that requires isolation
Hepatitis B and C without cardiopulmonary problems.
Diagnosed cases of active PTB (Class III), HIV and AIDS

Outcomes of collaborative practice

Patient outcomes: better patient care, cost-efectiveness, and improved
satisfaction
Nurse outcomes: more productive and efficient; more time for research and
self-improvement
Physician outcomes: increased efficiency and job satisfaction; less medical
errors; better understanding of other team members
Administrator outcomes: health care costs lower due to higher efficiency,
shorter hospital stay, fewer patient complications
Collaborative Practice in Action
Acute stroke team
Neonatal care team
Outcomes management team
Family involvement or collaboration
End of life comprehensive support team
Patient safety team (addition of pharmacist)
Management of ICU Resources
ICUs tend to adapt organization and resources to outputs

optimal distribution of resources demands that each ICU organization be determined

and controlled according to established national regulations

effective regionalization of CCM is only possible if the knowledge and practice of CCM
essentials are known by staff
OTHER COLLABORATING DEPARTMENTS/UNITS:
We are under the Office of the Deputy Director for Health Operations
Nursing
Paramedical staff
Physicians-in-training
Pharmacists
Infection Control Unit
Conclusion
The ICU is a complex, scarce resource unit but cost-intensive unit
Efficient management should be done to improve and maximize patient benefits
The UP-PGH CENICU is just one model out of several options
You may adapt several models that will suit your hospitals needs