The 16 bed Coronary Intensive Care Unit (CICU), under the direction of Dr. Joseph Brennan, is an integral component of the busy and diverse clinical in-patient service at Yale-New Haven Hospital and the Yale University School of Medicine. Yale – New Haven Hospital (YNHH) serves as the largest primary care hospital in New Haven, CT as well as a tertiary care center for Connecticut, southern Rhode Island, and parts of New York State. The patients from this extremely large catchment area represent a wide variety of both common and rare cardiovascular disorders and therefore provide a wide – ranging experience and exposure to varying cardiac conditions in a demographically and culturally diverse population.
The CICU provides extremely specialized and integrated care to effectively manage complex cardiovascular disease. Patients presenting with acute myocardial infarction (AMI), hypertensive urgency and emergency, hemodynamically unstable arrhythmias, cardiomyopathies, acute and chronic congestive heart failure, as well as those patients that have undergone complex percutaneous coronary interventions (PCI) or complex arrhythmia ablative procedures, as well as those patients requiring ventricular assist devices (VAD), are housed in the CICU. The CICU has been instrumental in the development and enhancement of the YNHH Therapeutic Hypothermia Protocol for survivors of out- of- hospital cardiac arrest. We expect continued growth in CICU patient volume through several clinical and research initiatives, including our TAVI (Transcatheter Aortic-Valve Implantation) protocol, continued growth of our Carotid Stenting and Peripheral Vascular programs, as well as continued expansion of our Ventricular Assist Device program.
The breadth of clinical exposure in the CICU provides both Internal Medicine, as well as Cardiovascular Medicine trainees unequaled educational opportunities to participate in the care of critically ill patients and the opportunity to provide high quality evidence-based patient care under the auspices of a dedicated teaching attending.
The Goodyer service, under the leadership of Dr. Lynda Rosenfeld, commenced as a formal house staff/fellow teaching service in July, 2010. The Goodyer Teaching Service consists of a Cardiology Attending, a General Cardiology Fellow and two resident physicians from the Traditional Internal Medicine/ Medicine-Pediatrics or Primary Care Training Programs. It is designed to provide expert and efficient care to those patients with a primary cardiac diagnosis such as chest pain, ACS (Acute Coronary Syndrome), syncope, valvular heart disease, hypertension, arrhythmias and congestive heart failure, who do not require treatment in the CICU. The Goodyer Service simultaneously emphasizes teaching and works to improve the continuity of inpatient and outpatient care. Unique features of the Service include a discharge clinic to see all vulnerable patients within a week after discharge in order to optimize their management and prevent readmissions. The service is also designed to provide residents with experiences in the various cardiac laboratories, including the nuclear imaging laboratory, the echo laboratory, the catheterization laboratory and the electrophysiology laboratory. Residents and Fellows are encouraged to follow and or participate in their patients’ diagnostic studies and non-invasive procedures.
The 5-4 Stepdown Unit, incorporated into the YNHH Heart and Vascular Center in August, 2010 has allowed a substantial growth in patient volume for those cardiac patients not meeting criteria for ICU treatment, but requiring a higher level of care than that found on medical floors. A substantial number of our VAD, as well as our hemodynamically stable CICU patients have been placed in this updated unit.
The in-patient Consult service, staffed by a full time Cardiovascular Medicine faculty member as well as a Cardiovascular Medicine Fellow, renders timely, detailed, and comprehensive cardiac consultations to the Medical and non-Medical specialties at Yale-New Haven Hospital. Specifically, this busy service provides shared medical management of both simple and complex cardiovascular conditions, as well as the utilization of appropriate diagnostic tests and the application of approved guidelines to patient care.
A 14 bed Observation Unit originally opened in March, 2011. This unit has increased to 26 beds. It is currently staffed by a full time Cardiologist as well as Medicine Hospitalist. This Observation Unit is designed to provide rapid assessment, diagnosis, and treatment for the specific diagnoses of Chest Pain and Syncope in low risk patients. This Observation Unit has proven to be quite useful in adding to our consultative and Goodyer Teaching Service volumes.