An intensive care unit patient who had undergone heart surgery had failed multiple attempts to tolerate extubation, the final step in liberating her from mechanical ventilation. A tracheostomy, or creating a hole in her windpipe, seemed to be the only alternative.
Three days before the procedure, her ICU nurses, respiratory therapists, physical therapists and intensivists collaborated to make her more comfortable. They used early mobility strategies, including allowing her to move while she was still on the ventilator.
The next attempt at extubation was successful, avoiding the need for the tracheostomy – Dr. Michael Johnson was a physician on that team.
Johnson, a critical care and internal medicine physician at the SSM Health St. Joseph Hospitals in St. Charles and Lake Saint Louis, has dedicated himself to several initiatives in the ICU designed to improve outcomes for critically ill patients, treat delirium and improve overall patient care.
His efforts led to his being nominated for the 2018 Excellence in Health Care Award from The St. Louis American Foundation.
“It is an honor for me to be nominated to receive this award,” Johnson said. “I do so while acknowledging all of the ICU multidisciplinary staff and committee members who are actively engage in our projects. This recognition reflects on their contributions as much as my own.”
Johnson’s contributions include the development of new medication processes to relieve pain and improve patient comfort, an increase in the level of family engagement, and an emphasis on patient mobility. He leads two committees focused on these tasks.
When Johnson was a child, he found himself surrounded by African-American physicians. Dr. William Ross was his family physician, Dr. Elmer Jackson was his best friend’s father, and Dr. Charles Cooper was the father of another one of his friends.
Each of these men served as mentors, and the medical field drew his interest. Johnson received his medical degree from the University of Nebraska Medical Center and began his career with SSM Health as an intensivist in 1994.
At the SSM Health location in St. Charles, Johnson developed a patient journal along with the help of the Society of Critical Care Medicine and individual healthcare contributors. The program is aimed at aiding recovery while reducing delirium and post-intensive care syndrome.
Journals include activities the patient participates in each day, the hospital environment, general observations, updates on family, friends and pets, missed holidays, special events or current events, and words of caring, presence, hope and encouragement.
Delirium is an acute alteration of a patient’s mental condition and is sometimes called “ICU psychosis.” Detecting, preventing and managing delirium can ultimately reduce time spent on ventilators and lead to a shorter stay in the hospital. The CAM-ICU Committee, Early Mobility Committee and the Wake Up and Breathe Committee handle each of these tasks, respectively.
Even after a patient is discharged from the hospital, their battle isn’t over. Patients can experience PTSD-like symptoms that can last for several months after they leave the hospital.
“Hallucinations, difficulty with focus or memory recall, personality changes, sleep disturbances, and impaired relationships and physical capacity can occur,” Johnson said. “Recent studies suggest that the use of a patient journal can help patients piece together fragmented, distorted memories of their ICU experience. With their family member's assistance, patients have found the journal to be beneficial in reducing the severity and duration of their prolonged delirium.”
Johnson’s inspiration to tackle such issues came from his own personal experiences, not his work as a physician. His mother had a stint in intensive care and passed away in 2013.
“Being in the role of a family member gave me a different perspective and appreciation for what ICU patients and families experience,” Johnson said. “Her illness prompted me to explore new and evolving aspects of patient and family care in the critical care profession.”
Johnson’s efforts have rendered results, both for his patients and for himself. Seeing patients recover from serious, life-threatening illnesses, along with working with the intensivists at both the St. Charles and Lake Saint Louis hospitals, have been the highlights of Johnson’s career.
“It is exciting to implement these innovations,” he said, “and to see the ways in which quality of life improves for patients and their loved ones.”