Critical Care (ICU and HDU)

Intensive Care Unit

East Surrey Hospital

01737 768511 Ext 1670

sash.icuenquiry@nhs.net

High Dependency Unit

East Surrey Hospital

01737 768511 Ext 2737

sash.icuenquiry@nhs.net

Matrons

Chris Beevers – 01737 231669 - chris.beevers@nhs.net

Carole Love – 01737 231669 – carole.love1@nhs.net

A patient whose condition is extremely serious, possibly life-threatening, is often taken to an Intensive Care Unit (ICU) which provides constant observation and treatment from specially trained staff qualified to use specialised equipment.

Some admissions to the ICU are planned, usually after major surgery or in order for specialist treatments to be performed.

You may also hear the unit referred to as ITU—that stands for Intensive Therapy Unit. It means the same as ICU.

Our unit is a combined ICU and High Dependency Unit (HDU). HDUs are for patients who require less monitoring or treatment than is normally provided in an ICU.

Due to clinical need, men and women are nursed next to each other on the unit—the staff will endeavour to maintain your relative’s or friend’s dignity at all times.

When you or your relative or friend is discharged they will either go to a side room or a single sex bay on a ward.

The Intensive Care Unit uses machines which can look frightening when seen for the first time. These machines help us to monitor and support a patient’s normal body functions.

Each patient is attached to a machine called a cardiac monitor. Small, sticky pads are placed on the patient’s chest and are connected to a machine.

The machine picks up electrical impulses from a patient’s heart and can detect any abnormalities. The monitor can also show a patient’s blood pressure and temperature. It is normal for the numbers on the monitor to keep changing.

Patients who are not strong enough to breathe on their own will be connected to a ventilator (breathing machine). This is attached to a tube passing through the nose or mouth into the windpipe. The tube, which is known as an endotracheal tube, is connected to a machine that blows air and extra oxygen in and out of the lungs.

The machine can ‘breathe’ completely for a patient or it can be set to assist a patient’s own breathing. Patients can be gradually weaned off a ventilator when their condition improves.

If a patient is likely to remain on a ventilator for more than a few days, the endotracheal tube is sometimes replaced with a tracheostomy. In this case an operation is carried out to insert a tube into a hole made in the throat. Although this can look quite strange, it is actually more comfortable for the patient than having a tube in their mouth.

Please remember that, although unable to speak, your relative or friend may be able to hear you. By all means do talk to them, but questions should be put so that they can be answered with a nod or shake of their head.

Patients are often attached to drips or infusions. These allow liquids to be passed through tubes into veins, usually in the side of the neck, arm or hand.

There are various substances commonly used in drips. Fluids can be used for various reasons including rehydration and maintenance of blood pressure. A pump is attached to the drip to administer the drugs at the correct rate.

Food, in the form of liquid, containing essential nutrients can be given either through the nose via a tube which goes down into the stomach, or by using a drip.

Your relative or friend will have a urinary catheter in order to empty their bladder. We measure the urine every hour so that we can assess how the kidneys are working.

Many of the machines have alarms and flashing lights. They go off quite often for a variety of reasons. Please do not be frightened by the lights or noises. The alarms are to attract the attention of the staff.

The nurse will be happy to explain the equipment to you. Please also take a look at the mural in the relative’s room and feel free to ask questions if you don’t understand something or would like to know more.

Always ask for clarification if jargon or technical terms are used. Staff working on the unit are used to this language and we sometimes forget how baffling and frightening it can be for other people.

There is a photo board in the corridor into the unit which shows the ICU team.

All staff wear different coloured uniforms (see the poster in the visitors room). Everyone will be wearing identification as it may be difficult to know if someone is a doctor, nurse, therapist or other member of the Critical Care team. Everyone on the unit should introduce themselves to you but please ask if you are unsure.

Medical team

On the unit we have Critical Care consultants who provide cover for the unit 24/7. You may be introduced to different consultants during your friend’s or relative’s stay, however they will have been given an in-depth handover of your friend’s or relative’s condition. The consultant is supported by a team of specialist registrars and core trainees.

Nursing team

Nursing care is provided by our team of Critical Care nurses. One nurse will usually look after one or at most two patients.

X-ray

What is it?

A film, similar to photographic film, is placed behind the part of the body being X-rayed. The X-ray machine fires a short burst of X-rays through part of your body.

The more X-rays that hit the film, the blacker it develops—so solid parts of the body that block many of the X-rays show up white (such as bones). Hollow or air-filled parts of the body show up black (such as parts of the lung).

Why are they done in Critical Care?

Chest X-rays are commonly used in Critical Care to look at people’s lungs and to check the position of intravenous lines and drains.

CT scan

What is it?

A CT scan, also known as a CAT scan, is a specialised X-ray test. CT stands for computerised tomography and CAT for computed axial tomography.

A CT scan can be done on any section of the head or body. It can give clear pictures of bones and soft tissue, such as muscles, organs, large blood vessels, the brain and nerves, which an ordinary X-ray test cannot show.

Why are they done in Critical Care?

The most commonly performed CT scan is of the brain to determine the cause of a decreased conscious level, or to assess serious head injuries. Other uses of a CT scan in Critical Care include:

• To detect abnormalities in the body, such as tumours, abscesses, abnormal blood vessels, fluid collections etc

• To give a clear picture of an area of the body before or after surgery

• To help doctors find the right place to take biopsies (tissue samples)

MRI scan

What is it?

MRI stands for magnetic resonance imaging. An MRI scan uses a strong magnetic field and radio waves to create pictures, on a computer, of tissues, organs and other structures inside the body.

An MRI scan can create clear pictures of most parts of the body so it is useful for all sorts of reasons where other tests (such as X-rays) do not give enough information required.

Why are they done in Critical Care?

MRI scans are used to get detailed pictures of the body to detect abnormalities.

The MRI scanner uses an extremely strong magnet, so some people cannot be scanned. This is because the magnet can potentially move medical devices with metal in them or affect their function—staff in Critical Care would check this before a scan is performed.

Bronchoscopy

What is it?

Bronchoscopy is a procedure which can help to diagnose and treat some conditions of the airways (bronchi) and lungs.

The bronchoscope is a thin, flexible telescope. It is passed through an endotracheal tube or tracheostomy and down into the bronchi and into the lungs. The tip of the endoscope contains a light and a tiny video camera so the doctor can see inside the airway and lungs.

Why are they done in Critical Care?

A bronchoscopy may be done to help diagnose respiratory (breathing) problems—this can be done by the doctor just looking, by taking samples of tissue (biopsies) or by taking samples of sputum. They can also be used to help treat pneumonia and chest infections by clearing the lungs of sputum.

Endoscopy/gastrostomy

What is it?

A gastroscopy is a test where a doctor looks into the upper part of your gut (the upper gastrointestinal tract). The upper gut consists of the oesophagus (gullet), stomach and duodenum. The doctor uses an endoscope to look inside your gut—the test is sometimes called endoscopy. An endoscope is a thin, flexible, telescope. The endoscope is passed through the mouth, into the gut. The tip of the endoscope contains a light and a tiny video camera so the operator can see inside your gut.

Why are they done in Critical Care?

A gastroscopy may be advised if the Critical Care team are worried that there may be bleeding from the gut. The doctors can then detect or rule out problems such as ulcers, gastritis (inflammation of the stomach), duodenitis (inflammation of the duodenum) or other conditions.

Lumber puncture

What is it?

A lumbar puncture (sometimes called a spinal tap) is a procedure where a sample of cerebrospinal fluid (CSF) is taken for testing. CSF is the fluid that surrounds the brain (cerebrum) and spinal cord.

This is done by inserting a needle through the skin and tissues between two vertebrae into the space around the spinal cord which is filled with CSF. Some fluid leaks back through the needle and is collected in a sterile pot. Sometimes we will also measure the pressure of the fluid. This is done by attaching a special tube to the needle which can measure the pressure of the fluid coming out

Why are they done in Critical Care?

This test is mainly used to diagnose meningitis (an infection of the meninges—the lining that surrounds the brain and spinal cord). It is also used to help diagnose some other conditions of the brain and spinal cord.

The day is planned as much as possible around the individual needs of your relative or friend. There is a basic structure to the day:

07:30 – 09:00 hours: Nursing and medical staff hand over from the night shift to the day shift. In this time the intensive care team meets to review each patient’s condition and decide any changes in treatment.

10:30 – 12:30 hours: Consultant ward round. This falls outside of our visiting hours but if visitors are in the unit during this time they will be asked to leave to maintain patient confidentiality.

Each patient’s individual plan of care will be carried out throughout the day and night. This may include physiotherapy, further tests on or outside the unit, changes to drips and tubes, or assessments and care by other members of our multidisciplinary team.

17:00 – 18:00 hours: Evening rounds to review the conditions of all our patients.Relatives will be asked to leave the unit during the evening ward round to maintain patient confidentiality.

19:30 - 20:00 hours: Night shift nurses start work.

Infection control

Infection control is extremely important in Critical Care and there are a number of ways you can help us in this area:

• Please ensure you clean your hands on entering and leaving the unit by either washing your hands or using the alcohol hand gel placed around the unit

• Please do not handle any lines or tubing

• Refrain from sitting on patients’ beds

• Do not bring flowers or plants into the unit

• Keep patients’ property to a minimum

• Do not bring young babies into the unit—however, in exceptional circumstances, please discuss this with the nurse in charge.

Please speak to a staff member if you have any queries about infection control issues.

Transport/parking

There are public transport options and a car park at the hospital—full details are on the Trust website.

Gifts and presents

Most patients in the unit are not able to eat or drink normally. Please check with the nurse before bringing in food and drink.

Flowers and plants are not allowed on the unit as they can spread infection to our patients.

We would suggest:

• Toiletries

• Personal music devices

• Photographs and cards from family

Clothing and property

There is limited storage space for personal property. While patients are in ICU they are not likely to need many items, however glasses and hearing aids are helpful in keeping people orientated.

If your relative or friend comes from home or another ward with property, you may be asked to take non-essential items home for safekeeping. If property is kept on the unit it will be recorded on a property form — please ask a nurse for a copy of this.

When patients start to get better and have less monitoring, it is nice for them to be able to wear their own clothes. A nurse may ask you to bring some in.

Cash, credit cards and jewellery should never be left at the hospital. Your own personal property should never be left unattended when you are visiting.

If the patient arrives on to the unit with any valuables they may be placed in the unit safe. Please check if this is the case and take any valuables home.

What is a critical care transfer?

This is the movement of very sick patients from one critical care area to another.

Why do we transfer patients?

Reasons for transferring sick patients can include:

• Tests or investigations

• Moving to a higher level of care

• Moving to specialist care, this would include for cardiac surgery, neurosurgery, burns, trauma, spinal, liver, renal or paediatric care.

• Moving to a lower level of care

• Returning to your nearest hospital to home

• Allowing access to critical care for others

Your medical and nursing team will be able to explain the reasons for your/your loved one’s transfer.  

What can you expect?

You/your loved one will be transferred by a team of staff who are familiar with the care of critically ill patients and the needs during transfer.

Depending upon the reason for the transfer, this will decide the speed at which it needs to be done.

Transport

The hospital staff will arrange an ambulance if required. Due to space on the ambulance it is not possible for relatives or friends to travel in the ambulance.

Please speak with your doctors or nurses regarding travelling to the new hospital.

Communication

Once a decision has been made about the transfer you will be informed by the hospital staff.  They will tell you about the following:

• Where you/you loved one is going

• Why they are going

• When the transfer will happen 

• What you need to do

• Contact details of where you/your loved is going  

Escorting staff and equipment

Where possible the staff transferring you/your loved one will be the staff that are currently looking after you.  However, on occasion, you/your loved one may have a different team who are familiar with the care of critically patients and the needs during transfer. 

The equipment used during transfer to support you/your loved one is specifically designed for transferring critically ill patients.  Staff are familiar with the equipment and you/ your loved one will be put on the transfer equipment for a period of time before leaving to ensure that everything is stable. 

Travelling to the new hospital or critical care area

If travelling by ambulance, loved ones and friends should make their own way to the new location; they will not be able to follow the ambulance.

In the event of an emergency it may be required for a diversion to an alternative destination. This will be to maintain the safety of the patient, and you will be notified as soon as practically possible.

On arrival

It will take time to handover your/loved one’s care and to transfer to the receiving hospitals equipment. Depending on the reason for the transfer there may also be a period of time you/ loved one are undergoing tests, investigations or treatment. The staff will give you information about how long this may take.

Making enquiries

We ask that the family or friends of the patient nominate one person who can phone the unit and pass the information on. This will save us repeating the same information to many different people.

At times it may be necessary to restrict the information we give on the phone to maintain patient confidentiality.

If you would like to talk to the doctor, please ask a member of staff and this can be arranged.

The direct line telephone numbers are:  

ICU – 01737 231670

HDU - 01737 232737

Using mobile phones

You are able to use your mobile phone but we ask that you restrict this to non-clinical areas only.

If you need to charge your mobile phone, please ask a member of staff first.

Filming or taking photographs of patients or members of staff without their permission is strictly prohibited.

Refreshments

There are shops selling snacks, sandwiches and drinks at the main entrance and a snack bar at the east entrance.

Visitors can also use the canteen which is situated on the first floor. 

Facilities

There is a cashpoint at the east entrance.

Toilets

There are toilet facilities for visitors in the waiting area.

Chaplaincy service

The multi-faith chaplaincy offers support to patients and visitors of all faiths or none to help with their spiritual and religious needs.

For a place of quiet, prayer and reflection we have the following available:

The chapel – near to the east entrance

Please speak to a member of staff if you would like to see a chaplain. The chaplaincy team is happy to make visits and can also arrange visits by ministers of other faiths and beliefs.

Interpreting service

We are able to book professional interpreters for patients or families who speak English as a second language.

Going to the ward

The consultant will decide when your relative or friend is able to be discharged from Critical Care to a ward. Your relative or friend will be seen by a matron covering the ward and the critical care outreach team will continue to see them once they have moved to a ward. Add link to CCOT section please

If a patient dies

The purpose of Critical Care is to treat seriously ill patients and hopefully help them recover. In some cases, however, despite all our best efforts, a patient will not recover.

In these situations, the doctors may need to discuss the appropriateness of further treatment. Doctors are usually able to prepare those concerned if their relative or friend is approaching a critical stage.

After a death

The death of someone close to you can leave feelings of anger, numbness, tiredness and helplessness, as well as deep sadness. Coming to terms with your loss can be a long process and it is perfectly natural for it to take time.  Our clinical psychologist is available 4 days a week and can support you when you visit if you wish.

You will be given a copy of the Trust’s bereavement guide. In this booklet there is practical information, advice and a list of organisations you can contact for additional support.

This guide will also have details of our Critical Care Bereavement Follow Up servicewhich is run by our clinical psychologist, a senior nurse and consultant. (add link to clin psych section)

You will also need to make an appointment with the bereavement officer—they, too, can offer advice and answer any queries.

Tell us what you think

It is important that any problems are dealt with quickly, at an early stage. Please talk to the staff on duty if you have any concerns.

If you feel unhappy about the way we have handled your concern please talk to the Matron in intensive care.

A relatives’ satisfaction survey is available for you to fill in either on paper or can be accessed via this link: (add link to visitor questionnaire)

There are also posters in the visitors room with the QR code. 

The surveys enable us to act on any suggestions you may have to improve our service.

Donations and gifts

If you would like to make a donation please follow the following link: XX.  Please note we are unable to accept cash.  Donations made to critical care have been used to fund the mural you can see in the relatives room as well as bereavement support supplies.