The last thing John Hynes remembers that March day is opening his cellar door. He doesn’t recall his descent down a full flight of stairs and slamming his scull on the cold basement floor after sustaining a cardiopulmonary arrest.
“I had to be resuscitated and brought back to life. I split open my head and needed 22 staples,” said the 67-year-old Lowell, Massachusetts resident, who ended up at Lowell General Hospital’s (LGH) Intensive Care Unit for seven days. “I was lucky to be where I was, and surrounded by the tremendous care and people.”
That team spirit that John experienced was due to a remarkable partnership happening in the intensive care units (ICUs) at Lowell General in recent years; the partnership between Wellforce members Tufts Medical Center in Boston and Circle Health, which includes Lowell General.
“This collaboration has allowed us to keep more patients close to home, where their loved ones can visit, and provide those patients with the same high level of care as they would receive if transferred to Boston,” says Ellen Scott, RN, nurse manager of the Lowell General Saints Campus Intensive Care Unit. “There is a sense of team here that is truly special.”
Greg Schumaker, MD, a Tufts MC Pulmonologist who now serves at Medical Director of Lowell General’s ICU. Dr. Schumaker says the project goal from the beginning has been to treat as many patients in the community as possible by bringing expertise and resources to the patient. So, Tufts Medical Center physicians experienced in complex case management travel to Lowell and staff their 22 ICU beds across two campuses.
“Lowell General is a highly functioning community hospital. It has a cohort of patients that tend to be sicker and have complex needs,” said Dr. Schumaker, adding that the hospital has a sophisticated and engaged staff of specialists. “We take care of the ICU patients and then pull in nephrologists, infectious disease specialists, cardiologists or whoever we need from Lowell General. Together, we provide state-of-the-art care for the patient.”
Dr. Schumaker also added nurse practitioners and physicians assistants to the ICU staff to help monitor patients and a rotation of Tufts Medical Center fellows, doctors who have completed their residencies and are specializing in critical care, to be part of the ICU teams. "These additions help broaden the provider pool while elevating the level of care," he says.
“We do daily multi-disciplinary rounds, going room to room, with the team – the attending doctor, the nurse, the ICU pharmacist, someone from pastoral services and social services, a respiratory therapist, and the fellow and mid-level,” said Scott. “There is a great deal of respect for each other and the opinions and ideas of each person. Nurses, as the patient’s primary caregiver, love being a part of this process.”
Once a month, the staff also participate in a bi-campus critical care meeting, an opportunity to share ideas, best practices and ensure consistent care is being given at both of Lowell General’s ICUs.
The changes have resulted in strong quality metrics. While Lowell General Hospital has always done a good job in controlling infection rates, Dr. Schumaker says the morality rate of septic shock and severe sepsis has long been an issue for all hospitals.
“Our multi-disciplinary group focuses on this. And as a result, we’ve seen a significant decline in our severe sepsis and septic shock deaths over the last few years – we’ve cut them by about a third,” said Dr. Schumaker.
The team approach also has benefits for family members of those in intensive care.
“There is always someone here to speak with families. If you have a loved one in an ICU bed, you want to know what is happening or communicate what you are noticing as a family member,” said Scott. “It gives them great comfort to be able to get answers quickly.”
Lowell General is now looking to improve the physical space of their ICUs. It has begun constructing a new ICU on its main campus, scheduled to open in January of 2017. Dr. Schumaker says future plans include expanding the number of ICU beds.
“This will prevent us from having to send people into Boston, simply because we do not have a bed available here,” said Dr. Schumaker. “We’ve seen the tremendous benefit of keeping patients close to home. We want to do everything we can to meet the need.”
There are times when a patient becomes so sick that specialized services only available in Boston are required, notes Dr. Schumaker. That’s when the Tufts MC and Lowell General connection goes into overdrive. Dr. Schumaker and his team in Lowell are colleagues with the ICU teams at Tufts MC. They know each other well, have worked side by side and can rapidly share patient information, he says. The result is a seamless transfer to Boston for the benefit of the patient and family members.
For John Hynes, the Lowell General and Tufts MC partnership meant a great deal.
“My family was at my side the whole time. The staff kept them updated on my condition. The care was just excellent,” he said, noting he needed significant follow-up care following the accident. “(The experience was) so good that I just had my knee replaced there. And I have my cardiologist there.”
“It took a while to sink in just how close I came to the end,” said Hynes. “I’m very lucky.”