Critical Care Program

For 35 years, PACCS faculty physicians staffed the MICU service at the University of Minnesota Medical Center leading the medical team of fellows, residents and medical students. UMMC is a quaternary-care referral hospital specializing in transplantation and oncology and accepting patients with complex multi-system diseases from facilities cross the upper Midwest. 

In 2008, in addition to the staffing the MICU service at UMMC, faculty physicians from the PACCS Division started an on-site intensivist service at the 23-bed mixed med-surg-neuro ICU at Fairview Southdale in Edina, MN. This was one of the first examples of University of Minnesota faculty physicians establishing an academic medicine practice in a large community hospital.  In 2009, in collaboration with the Division of Surgical Critical Care in the Department of Surgery, the practice expanded to the 12-bed ICU at Fairview Ridges hospital in Burnsville.  Three years later, we developed the UMP-Fairview System-wide Tele-ICU program which was the first non-Federal Tele-ICU Program based in Minnesota.

The M Health-Fairview Critical Care program has matured into an integrated medical-surgical-anesthesiology-Advanced Practice RN Critical Care Service providing on-site care in three Fairview hospitals with 24-hour coverage at UMMC and Southdale and tele-ICU care to five other ICUs. This represents the largest UMP hospital-physician practice effort outside of UMMC. The program supports approximately 40 intensivists and 8 APPs housed in the academic departments of Medicine, Surgery and Anesthesiology. Between the three departments, we have seven daytime faculty intensivists and two nighttime intensivists providing ICU services at three hospitals and the tele-ICU.  In 2018-2019 with the merger of the HealthEast system into Fairview Health Services and the clinical integration of Fairview and University of Minnesota Physicians, the M Health-Fairview Critical Care program now comprises 13 ICUs in 10 hospitals under the leadership of Jeff Chipman, MD. 

From 2012 to May 2017, the Tele-ICU program had 54 cameras and continuous telemetry monitoring for patients in five Fairview ICUs and one Intermediate Care Unit.  The tele-ICU serves as the main triage hub for adult ICU transfers to the two large Fairview ICU programs, UMMC and Southdale.  This permits efficient load leveling of the ICU census across the Fairview system while preserving ICU beds at UMMC for tertiary-care transfers from other hospitals in the Upper Midwest. In 2017, Southdale ICU was converted to a 24-hour direct care ICU which decreased the tele-ICU beds to 38. However, the tele-ICU program will expand again to the ICUs at Grand Itasca hospital in Grand Rapids and Bethesda Rehabilitation Hospital in St Paul. 

Clinical practice standards and quality improvement programs for 13 ICUs through a common EMR (Epic) are supported by a system-wide steering committee comprised of ICU medical and nursing directors, clinical nurse specialists and pharmacists assisted by ICU system analysts and administrators.

The Critical Care program focuses on care standardization to improve patient outcomes but also to minimize the effects of practice variability for clinical trials in sepsis, sedation and ARDS.  For instance, there are common ventilator order sets, RT-driven weaning protocols and bronchoscopy BAL collection techniques.  Adjunctive therapies for mechanically ventilated patients such as sedative drug selection and daily stops, prone positioning, order-set mandated sedation goals, early mobility and enteral feeding protocols and rounding checklists are standardized.  Junior intensivist faculty in the three Departments gain administrative experience in QI and system standardization preparing them for ICU medical directorships, database research projects and implementation of new clinical practices. 

Educational activities

PACCS faculty intensivists supervise the 4th-year Medical-student sub-internship clerkships at UMMC, Ridges and Southdale hospital. This mandatory clerkship started in 2015 and teaches the basics of life support and ICU care to approximately 200 students per year. Ron Reilkoff, MD from PACCS is the clerkship director. 

Since July 2018, there is a month-long GME-supported critical care rotation at Southdale ICU for fellows from Medicine, Surgery or Anesthesiology programs.  The fellows gain experience in managing complicated medical, CV surgery and neurocritical care patients in a single unit with direct attending-to-fellow supervision.

The MICU service at UMMC has long provided an excellent educational experience in tertiary critical care for the P/CC fellows and residents in the University of Minnesota Internal Medicine Residency and Family Medicine programs. In 2011, intensivists from the three academic Departments started over-night in-house coverage at UMMC for both the SICU and MICU services. This allows nighttime residents from either the Medicine or General Surgery residencies to interact with faculty intensivists trained in other critical care pathways.  This cross-training experience is likely unique amongst U.S. IM residency training programs. 

There is a joint fellowship education curriculum between the medical and surgical critical care fellowships with monthly conferences held in the Surgery Conference Room.  The critical care faculty present a twice-yearly two-day Fundamentals in Critical Care Support training course (M Brunsvold, MD, director) to hospitalists, pharmacists and ICU RNs that practice in community ICUs across Minnesota. 

Scholarly Activities

Faculty from the Critical Care program publish approximately 10 papers per year from clinical observations or trials performed at UMMC and Southdale ICUs.  PACCS faculty have recruited subjects for proteomic studies in ARDS; randomized trials in patient-controlled sedation and early sepsis management. These and other studies have been supported by R-01 (NHLBI), R-21 (NINR), P-50 (NIGMS) and University of Minnesota KL-2 grants.  The three academic departments jointly fund three to five $12-15,000 seed grants yearly prioritizing support for junior faculty projects.  About 1/3 of the PACCS fellows’ scholarly output is related to critical care research. 

Hospitals

University of Minnesota Medical Center

14- Bed Medical ICU

Medical Directors
David H. Ingbar, MD
William Browne, MD

Address
University of Minnesota Medical Center - Fairview
500 Harvard Street
Minneapolis, MN 55455

Fairview Southdale Hospital

24-Bed Medical/Surgical/Neurologic ICU

Director
Ron Reilkoff, MD

Address
Fairview Southdale Hospital
6401 France Avenue S. 
Minneapolis, Minnesota 55435-2199

Fairview Ridges Hospital

12-Bed Medical/Surgical ICU

Medical Director
Jeff Chipman, MD

Address
Fairview Ridges Hospital
201 E. Nicollet Boulevard
Burnsville, MN 55337