The Intensive Care Unit is a place where the hospital looks after its most unwell patients and supports those that have undergone complex or high-risk operations. By its nature, it is a busy and very active clinical environment installed with some of the most advanced patient monitoring systems and life support technologies and staffed around the clock by a dedicated team of Critical Care doctors, nurses and allied healthcare professionals.

 

Morning handover

The day shift begins with a Nursing Handover meeting at 0730 where the night shift leader delivers a short briefing about each patient to the nurses taking over the shift and each nurse is allocated a patient to look after. Each Staff Nurse will then receive a detailed handover from their counterpart on the night shift at the bedside to ensure seamless continuity of care. This is also a time when safety checklists are completed and bedside equipment stocks are replenished.

The Intensive Care doctors and consultants meet for their handover meeting at 0800 where each patient's overnight progress is reviewed and any urgent matters are raised for discussion. It is also a time where consideration is given to unwell patients out on the wards or in A&E who may require further review or admission to the Unit, and to patients booked for advanced post-operative care following high-risk elective surgery. This enables the medical team to make an early assessment of the likely service demands for that day and develop a strategy for prioritising the needs of patients who may require Critical Care.

 

Morning assessments and ward rounds

The morning is a very busy time when the doctors conduct their daily assessments and ward rounds, important tests like X-rays and ultrasounds are ordered and carried out and specialist teams of doctors come to visit and review patients on the Unit. The physiotherapists often do many of their assessments and therapies in the morning too, and the nurses attend to the needs of their patients as they transition from nighttime into daytime. For these reasons, we suggest avoiding morning visits to see your friend or relative if possible.

The main ward round tends to take place between 1030 and 1300, although it may take longer if the needs of our patients are more complex. It is led by the Intensive Care consultants and made up of junior doctors, the nursing Shift Leader, bedside nurses and a pharmacist. Here, a more detailed and thorough assessment is made and a comprehensive plan is put in place for each of our patients.  This includes a review of each patient’s pain relief, nursing, rehabilitation and emotional needs and medication.

 

Lunchtime meetings

On Tuesday lunchtimes, we hold a Multidisciplinary Team meeting in our Seminar Room which is attended by all the Intensive Care consultants, a selection of junior doctors and members of the nursing staff who are free to attend, and our dietician, physiotherapists and pharmacist. This provides an important forum to discuss our patients and gather a consensus of opinion as to how best to tailor care to serve their needs and best interests.

There are further ward rounds on Mondays, Wednesdays and Fridays from 1400 to 1430 when our Microbiology colleagues come to visit to give their expert advice on the management of infections and prescriptions of antibiotics. Infection and sepsis are frequent causes of critical illness but it is important to remember that very unwell patients are more susceptible to catching new, opportunistic infections during their stay, particularly as their immune systems tend to be temporarily weakened and they are vulnerable to ventilator and invasive line-associated infections. These frequent liaisons with the Microbiologists help us to keep an eye on the bacteria, viruses or fungi that pose a risk and determine which antibiotics are going to be most effective.

 

Afternoon visiting

Afternoons from 1430 are often the best time to come and visit as there will usually be fewer interruptions. By this time, the doctors will have usually finished their rounds and main tasks and are more available to come and update family members with recent events and progress. For our longer stay patients, the Unit does its best to offer some degree of normality with radios, televisions and even visits outside to the garden if the weather permits!

 

Service planning

At regular intervals throughout the day, the Intensive Care registrar on call, the Critical Care Outreach nurse, the consultants and shift leader liaise with one another to maintain an overview of sick patients within the hospital that other medical teams have asked for Critical Care specialist input. As the Intensive Care Unit is a scarce resource, operating at close to 100% bed occupancy, these meetings form a crucial part of daily service planning to ensure the Unit is able to quickly respond and react to the dynamic needs of patients within the hospital.

 

Night shift handover

The day shift comes to an end at 2000 when the nurses will have completed a handover to their night shift colleagues and the doctors start their handover ward round with the night doctor. The lights are dimmed at 2200 and remain so until 0700; noise is also kept to a minimum in order to promote a good night’s sleep. Sometimes noise and activity throughout the night is inevitable, particularly if new patients need to be admitted in the small hours, or sleep may be hard to come by as a result of disruption to the day-night cycle, also known as the circadian rhythm. If this is a significant problem, our staff will do their best to address it and the doctors may advise the use of some short term medication to help.

 

Behind the scenes

Much work goes on behind the scenes to keep the Intensive Care Unit running smoothly. Our ward clerk and administrative support staff ensure communications are answered promptly, notes are properly filed and all the necessary paperwork is completed to allow us to function. Specialist engineers help keep our equipment in working order and housekeeping services perform rigorous deep cleans on a daily basis to minimise the risk of transmitting infection to our patients. Our thanks go out to them and the many others that help our Intensive Care Unit deliver the very best care it can.