Leading the Way in Critical Care
- October/November 2007
- Français
For Dr. Neil Malcolm, Niagara's newest Intensivist, the opportunity to come to Canada to be in charge of a new way of delivering intensive/critical care couldn't have happened at a better time. "I chose to make a move to another country this late in my career because Ontario is leading the world with a new model of delivering intensive care and I wanted to be part of that," Dr. Malcolm says. "My first passion in medicine was intensive or critical care and I trained in critical care medicine in both the U.S. and Canada."
Arriving in Niagara this September from a teaching hospital at Dunfermline near Edinburgh, Scotland, Dr. Malcolm is an Anaesthetist, the specialists typically in charge of Intensive Care Units (ICU) in Europe, unlike Canada. Here, Intensivists (specialists in critical care), Internists (specialists in internal medicine) and other specialists from the Department of Medicine usually admit patients to ICU's. Anaesthetists work in the Department of Anaesthesia and/or Surgery, providing pre-surgical, surgical and post-surgical care to patients under anaesthetic.
"The Niagara Health System (NHS) recruited me to head the development of a new critical care network for Niagara, starting with a change in physician referral practice at St. Catharines General Site in the ICU," Dr. Malcolm explains. Until now, Niagara's busiest ICU has had patients admitted to the unit by a variety of physician specialists. Since June, the St. Catharines General Site (SCG) unit has been 'closed', meaning that only Intensivists now admit patients to ICU from a surgical, medical, or emergency department bed. These critically-ill patients are admitted from all corners of Niagara.
Lead Intensivist Dr. Neil Malcolm with Critical Care Manager Jennifer Hansen
This change in admission to ICU is having a beneficial effect, says Jennifer Hansen, Critical Care Manager at SCG. "The establishment of our Level 3 (advanced critical care) ICU has really streamlined and improved the services we provide and the care we give our patients," Jennifer says. "Our nurses are very happy with this new model of care because we have a dedicated physician right here who can be at the patient's bedside in seconds. It's improved our multi-disciplinary teamwork and we have full engagement from all our health care professionals in a common goal – making sure we are providing the best care for our patients."
"For families, having the physician right there and available to talk to them at any point during the day is a much better way to communicate. I believe our patients and their families feel more valued. Everyone seems a bit calmer in our department now, from the nurses to the family members," Jennifer says.
One Critical Care Team - Three Sites
Dr. Mohammed Nassoh Hafez came on board as an Intensivist, also at SCG, earlier this year, and helped launch the new model of admission. "With our new Intensivists at SCG and the Internists and other specialists admitting patients to our ICU's in Welland and Niagara Falls, we are trying to better co-ordinate our care, so that patients across Niagara get the critical care they need when they need it," Jennifer says. "We're working together more as a team instead of three separate departments."
Ontario's Society of Critical Care Medicine is focused on 'putting the right patient in the right bed at the right time' and the NHS is working to make that happen, says Jennifer. "The most critically-ill patients in Niagara should be receiving their care at the St. Catharines ICU and we now have a process to ensure we have beds available for them. The new team, under Dr. Malcolm's leadership, will allow us to provide expanded critical care services around the clock. I want to point out that some critical trauma cases will continue to be transferred from here to Hamilton for specialty care, such as neuro (brain) and cardio (heart) surgery. We're fortunate that we have these highly-specialized services available nearby."
Dr. Malcolm spends half of his time delivering clinical care to ICU patients and the remainder administering the critical care program at all NHS sites. "I've been here since early September and I'm here because I believe Ontario is leading the world in intensive care treatment," Dr. Malcolm says. "It's great to be part of that exciting process. The NHS has an extremely enlightened vision of critical care – we're part of a developing process in the province and we're helping to lead in the advance."
There are several priorities for Dr. Malcolm as he settles into life at the NHS. "My primary focus is the implementation of the Level 3 critical care service at SCG. My second focus is to expand our program with the help and advice of the other ICU's in the NHS and thirdly, I want to work more closely with McMaster University to develop more programs for academic training of junior doctors in critical care."
On a personal note, Dr. Malcolm has a "five-year battle plan" to bring his wife and four children now young adults, to Canada, where their dual citizenship will provide more options for post-secondary and career opportunities. "My wife is Canadian and looks forward to coming home from Scotland."
For committed health care professionals like Dr. Malcolm and the critical care team, knowing an improved service is making a positive difference to patient outcomes is more than just rewarding – it's vital. "We have a great opportunity to better serve patients and create a stronger and more effective network of care for better patient outcomes," Dr. Malcolm says. "I'm amazingly impressed at the level of advancement of critical care in Ontario and am privileged to help in an ongoing process."