“I’m going to be here all night if you need anything.”
That reassuring statement is one parents of patients in St. Louis Children’s Hospital’s pediatric and cardiac intensive care units (ICUs) have heard from attending physicians since an in-house call program was initiated in June 2017. The new approach to overnight coverage is one being adopted by pediatric ICUs across the country, according to Washington University physician Juliane Bubeck Wardenburg, MD, PhD, division chief of critical care medicine at St. Louis Children’s Hospital.
“We take care of children with extremely complex, multisystem disease,” she says. “The clinical acumen, guidance and bedside presence of attending physicians—especially for the critical decisions that need to be made for these patients—cannot be replaced.”
She adds, “We also have a responsibility as faculty to support the education and clinical opportunities of our trainees, and to do that day and night. We want to ensure our trainees always have support when faced with new or technically challenging situations.”
The previous model of overnight coverage followed the long-established practice of on-call attending physicians deciding whether they could leave hospitals by assessing the acuity of their ICU patients. The new model eliminates the need for attendings to make that determination; instead, they are always in the hospital and available for consultation. This approach allows trainees to continue leading care while still receiving support when needed.
“Another important advantage of this change is that it enables us to take better advantage of opportunities to advance care overnight,” says Dr. Bubeck Wardenburg. “Previously we wouldn’t necessarily have taken out a patient’s breathing tube at 2 a.m. when an attending wasn’t available. Now, instead of needing to give patients another dose of sedative to keep them asleep until 6 a.m., we can remove the tube when the patients are ready. This is just one example of how our in-house call program is aiding us in doing what is best for our patients in a timely manner.”
Supporting the around-the-clock availability of ICU attending physicians is the hospital’s physician access line, Children’s Direct. “Having this single number by which attending physicians in the hospital’s other units and referring physicians can immediately reach our ICU attendings is transformative,” says Dr. Bubeck Wardenburg. “This encompasses our patient transport calls as well, which now have an attending on the line 24/7.”
For more information about the in-house call program or the hospital’s PICU or CICU, call Children’s Direct at 800.678.HELP (4357).