Healthcare Musings

ICU Lecture Series: The ICU Liberation Bundle

In this latest episode of the ICU Lecture Series, Dr. Hassaballa lectures to staff about the ICU Liberation Bundle. 
Link: https://sccm.org/clinical-resources/iculiberation-home/abcdef-bundles 

What Is A Blood Transfusion, Truly?

Despite multiple specialty society guidelines recommending not to transfuse blood if the hemoglobin levels are above 7-8 g/dL, many physicians disregard the recommendations. Why is that? Dr. Hassaballa discusses this issue. 
 
Article referenced in the show: https://www.pulmccm.org/p/guidelines-on-red-cell-transfusion 

ICU Lecture Series: Metabolic Acidosis

In this latest ICU lecture series, Dr. Hassaballa discusses metabolic acidosis: how to diagnose it and what to do about it. 

Great Minds in Medicine: Dr. Elaine Chen

What would someone who is BOTH a Critical Care and Palliative Care Doctor say about palliative care in the ICU? I asked one. 
 
Links from the show: 
The Coleman Palliative Medicine Training Program: https://colemanpalliative.org/
 
Research Articles referenced in the episode: 
Norton SA, Hogan LA, Holloway RG, Temkin-Greener H, Buckley MJ, Quill TE. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med. 2007;35(6):1530-1535. doi:10.1097/01.CCM.0000266533.06543.0Chttps://journals.lww.com/ccmjournal/toc/2007/06000Braus N, Campbell TC, Kwekkeboom KL, et al. Prospective study of a proactive palliative care rounding intervention in a medical ICU. Intensive Care Med. 2016;42(1):54-62. doi:10.1007/s00134-015-4098-1https://link.springer.com/article/10.1007/s00134-015-4098-1Ma J, Chi S, Buettner B, et al. Early Palliative Care Consultation in the Medical ICU: A Cluster Randomized Crossover Trial. Crit Care Med. 2019;47(12):1707-1715. doi:10.1097/CCM.0000000000004016https://journals.lww.com/ccmjournal/fulltext/2019/12000/early_palliative_care_consultation_in_the_medical.5.aspxCampbell JL, Piscitello GM. Does Reframing Do Not Resuscitate to Beneficial Care Only Increase Acceptance of No-CPR Orders?. Chest. 2025;167(1):211-221. doi:10.1016/j.chest.2024.08.027https://www.sciencedirect.com/science/article/pii/S0012369224050748?via%3DihubHochberg CH, Gersten RA, Aziz KB, et al. The Real-World Effect of Early Screening for Palliative Care Criteria in a Medical Intensive Care Unit: An Instrumental Variable Analysis. Ann Am Thorac Soc. 2025;22(2):247-254. doi:10.1513/AnnalsATS.202407-702OChttps://www.atsjournals.org/journal/doi/full/10.1513/AnnalsATS.202407-702OCPiscitello GM, Lamadrid VJ, Post Z, et al. The Effect of Triggered Palliative Medicine Consults on Nurse Moral Distress in the Medical Intensive Care Unit. Am J Hosp Palliat Care. 2022;39(9):1039-1045. doi:10.1177/10499091211049398https://journals.sagepub.com/doi/full/10.1177/10499091211049398
 

From the Appeals Desk: Coding Clinics and Sepsis

Many payers state that a 2016 Coding Clinics article allows them to deny sepsis DRGs. This is not true, and Dr. Hassaballa goes into the article and what is specifically says about sepsis. And, he issues an unequivocal condemnation of the murder of Brian Thompson. 

Great Minds in Medicine: Dr. Sergio Zanotti

In the latest installment of the "Great Minds in Medicine" series, I sit down with Dr. Sergio Zanotti, Critical Care Chief Medical Officer for Sound Physicians. We had a wide-ranging discussion about medicine, critical care, and healthcare in general. It was, perhaps, one of my favorite conversations. 
 
Discussed during the podcast: 
 
The Ventilator (Hidden Brain Podcast): https://hiddenbrain.org/podcast/the-ventilator/
The Diving Bell and the Butterfly (book): https://en.wikipedia.org/wiki/The_Diving_Bell_and_the_Butterfly 

Faith in the ICU: Does Being a Physician Weaken My Faith?

Given that physicians frequently make life and death decisions, especially in the ICU, does being a physician weaken one's faith? Dr. Hassaballa reflects on his own experience of faith and being a doctor. 

Most Oncologists Do Not Refer to Palliative Care. What?

Despite a strong recommendation by the American Society of Clinical Oncology in its guidelines, recent surveys indicate very few, if any at all, Oncologists refer patients to Palliative Care. This is a huge disservice. 

Great Minds in Medicine: Dr. Mohammad Alo

I sit down with Dr. Mohammad Alo, America's Cardiologist and great friend of mine, and we discuss all things cholesterol and social media best practices for Doctors. 
Dr. Mohammad Alo on X: https://x.com/MohammedAlo 
Website: dralo.net/links

What If An Unresponsive Patient Is Actually "In There"?

Recent research shows that a substantial minority of patients have cognitive motor dissociation. This has many important implications for our practice of critical care medicine. 
 
NEJM Study: https://www.nejm.org/doi/full/10.1056/NEJMoa2400645
NY Times Column: https://www.nytimes.com/2025/01/11/opinion/covert-consciousness-unresponsive-brain.html