What is critical care?

Intensive Care Unit (ICU)
Purple Zone
Level 3

General High Dependency Unit (HDU)
Green Zone
Level 3

What is critical care?

Critical Care is a term that incorporates both intensive care and high dependency units. Critical care is the treatment and monitoring of people who are in a critically ill or unstable condition.

A patient may require admission to intensive care because they need advanced respiratory support (ventilation), advanced renal support (haemofiltration) or other complex therapies following an acute episode of illness or after receiving a complex operation.

Admission to the high dependency unit may be required due to the complex nature of the patent’s surgical procedure or existing medical condition/s. Alternatively, they may be stepping down from the intensive care unit and need more complex monitoring and intervention prior to going back to a general ward.

Level 0
Patients whose needs can be met through normal ward care in an acute hospital.

Level 1
Patients at risk of their condition deteriorating, or those recently relocated from higher levels of care whose needs can be met on an acute ward with additional advice and support from the critical care team.

Level 2
Patients requiring more detailed observation or intervention including support for a single failing organ system or postoperative care, and those stepping down from higher levels of care.

Level 3
Patients requiring advanced respiratory support alone or basic respiratory support together with support of at least two organ systems. This level includes all complex patients requiring support for multi-organ failure.

As per the Intensive Care Society guidelines, Level 3 patients require a registered nurse to patient ratio of a minimum 1:1 to deliver direct care. Level 2 patients require a registered nurse to patient ratio of a minimum 1:2 to deliver direct care.

This is a guide and therefore from time to time, unforeseen circumstances will arise meaning that your loved one may not receive the desired nurse:patient ratio. However, we endeavour to continue to provide a high standard of care and patient safety remains a priority.

The Early Stages

We understand that it can be a very upsetting and stressful time when your loved one is first admitted to critical care. It is completely normal for you to feel a whole host of emotions.

On admission to the unit, our priority is to settle your loved one in as quickly and as safely as possible so you are then able to come in and be with them. When someone is critically unwell, this process can take longer because of multiple requirements needing to be met in order to support your loved one. This may include them being connected to an array of equipment in order to support them during their time in critical care.

The Unit Routine

The daily routine of a critical care unit is subject to change due to emergencies. The below gives you an idea of what your loved one’s day will entail:

Nursing handover

This happens once per shift and takes place at your loved ones bedside. A nursing handover occurs when one nurse hands over the responsibility of care for a patient to another nurse. It is an opportunity to explain the background of a patient’s condition, what support they are receiving, what has happened during the day and the most up to date plan. It is also when the registered professionals will discuss any medications that your loved one is receiving or will be due during the next shift.

Consultant ward round

All patients are reviewed by the ICU or HDU consultant along with the critical care junior doctors. It is the opportunity for patients to be reviewed and treatment plans to be discussed and put in place. The microbiology consultant will also be contacted to provide advice regarding the interpretation of results from blood samples sent following a patient becoming septic and the appropriateness of further investigations and antibiotic treatment.

Physiotherapy

The physiotherapists role within ICU can be separated into two important areas: respiratory and rehabilitation. Our physiotherapy team will aim to see your loved one on a daily basis, whether it be to help with their sputum load, which may or may not be affecting their oxygenation, or by promoting mobilisation while helping to maintain and improve muscle strength and improve joint movement.

Medications

Throughout the day and night, your loved one will receive multiple medications with the aim of improving their condition. These will range from sedatives, antibiotics, and medications to help with low or high blood pressure and many more. Your loved ones medication is reviewed on a daily basis on the ward round to ensure they are still required or need to be changed. Critical care has a designated pharmacist whose role it is to ensure the safe administration of medication for each patient.

Nursing care

Your loved one will receive care on a 1:1 or 1:2 nurse to patient ratio as previously mentioned. The role of the bedside nurse includes monitoring your loved ones vital signs and adjusting care accordingly, changing their position to prevent pressure sores, administering medication and taking blood tests.

Dietitian

Nutrition during critical illness is vital in aiding your loved ones recovery. The dietitian will aim to see the patient multiple times a week to ensure their nutritional requirements are being met. If your loved one is unable to eat and drink, the dietitian will help ensure they are getting their requirements through a tube – either into the gut or straight into the blood supply.

This is just a small number of health care professionals who will play a part in your loved ones care. The safety of our patients is a priority. We always aim to provide the highest standard of care.