Intensive Care Service

Seeing your relative

This is the question most families ask first, and this page cannot answer it yet. The visiting times for the intensive care units are not published, and we will not guess them here. Ask the nurse in charge of the unit, or call 040 4699 9999. That is the same line as the emergency number, so it is answered at any hour.

Intensive care units limit how many people come in and for how long. That is to protect patients, who catch infections more easily than they would on a ward. If you are asked to wait, it is not to keep you away from them.

• Ask the nurse in charge for the visiting times for that particular unit
• Ask before bringing in food, flowers, clothes or belongings
• Clean your hands going in and coming out
• Tell the nurse if you, or anyone with you, has a fever, cough, cold or loose motions

Who to talk to, and when

The nurse at the bedside knows what has happened in the last few hours and is the person to ask first. The treating doctor leads the care and sets the plan with the intensive care specialists.

There is no published time for the daily family update, so ask the nurse in charge when the treating doctor will be on the unit and where the family should wait.

Money and paperwork are handled by a guest relations executive, not by the nurses. Ask the nurse to call the guest relations executive for that floor.

Choose one person in the family to be the main contact and to pass news to everyone else. It is easier on you, and it keeps the story straight.

• Bedside nurse: what has happened today, and what the numbers on the monitor mean
• Nurse in charge: visiting, what you may bring, when the doctor will be on the unit
• Treating doctor: the diagnosis, the plan, and what to expect
• Guest relations executive: admission papers, estimates, insurance and the bill

The machines around the bed

The room looks alarming the first time. Most of what you can see is there to measure, not to treat. Alarms go off often, and an alarm usually means a lead has slipped or a bag needs changing rather than that something terrible has happened. Ask the nurse what any one of them is for. It is a fair question and they are used to it.

• A monitor above the bed, showing heart rate, heart rhythm, blood pressure and oxygen level
• A ventilator, if the patient needs help with breathing, joined by a tube through the mouth or at the neck
• Pumps on a stand, giving medicines and fluids in measured amounts
• A tube for feeding, and a tube draining urine, so that both can be measured
• A dialysis machine, wheeled to the bedside when the kidneys need support
• Soft leads on the scalp, if the electrical activity of the brain is being recorded

What the team does at the bedside

Some things are brought to the patient rather than the patient taken to them. That matters when someone is too unstable to be moved to another floor.

• Breathing support, on a ventilator or through a mask
• Monitoring and support of blood pressure and circulation
• Bedside echocardiography and ultrasound scanning
• Continuous dialysis (CRRT) and slow low-efficiency dialysis (SLED) at the bedside
• Tracheostomy, a breathing tube placed at the front of the neck when breathing support is needed for longer
• 24-hour EEG monitoring for patients with seizures or brain injury
• Blood and blood-product transfusion
• Physiotherapy in the bed, and feeding worked out with a dietitian

How long it lasts, and what comes next

No one can tell you at the start. Intensive care is usually counted in days rather than hours, and progress is rarely a straight line: a better morning can be followed by a worse night without anything having gone wrong. Ask each day what has changed since yesterday.

When a patient no longer needs care minute by minute, they move to a step-down unit. The monitoring is much the same there and one nurse looks after more patients. After that comes a ward bed, then discharge. Leaving intensive care is good news, even though it can feel like losing a safety net.

After heart surgery, for example, a move to the cardiac step-down unit within a day is common. Longer and more complicated operations take longer.

What it costs, and insurance

The daily charge for an intensive care bed is not published, and this page will not invent a figure. Ask the guest relations executive for a written estimate. Estimates are given at financial counselling, and you should be told when the plan of care changes in a way that changes the cost.

If the patient has health insurance, the guest relations executive collects the documents and sends them to the insurance company or third party administrator for pre-authorisation, then tells you the outcome. Under the Aarogyasri scheme the hospital applies online for approval and the government pays.

If an insurer refuses the final bill, the bills, reports and claim forms are handed to you at discharge so that you can claim the money back yourself.

Charges are posted to the bill as they are used, so you can ask for the running total at any point instead of waiting until discharge.

Who decides that a patient goes into intensive care

The treating team or the emergency department decides, based on how ill the patient is. A family cannot book an intensive care bed, and it is not something you can buy. We know that is hard to hear when you are frightened and want to do something.

What you can do is speak up. If you think your relative on the ward is getting worse, tell the nurse straight away. Staff would far rather hear it early.

Patients also come in from the operating theatres after major surgery, and from other hospitals when the care they need is not available where they are. A transfer between hospitals is arranged between doctors, so ask the doctor treating them now to call us.

If someone is seriously ill at home, do not wait for an appointment or a bed. Bring them to the emergency department, which is open 24 hours a day, every day, or call the ambulance on 1800 2024.

The units, and what each one is for

Intensive care runs over two floors. Which unit a patient goes to depends on what is wrong and which team is treating them. The bed numbers and nurse to patient ratios below are as the hospital publishes them, and they come to 104 beds. The transplant and isolation ICU beds are not counted among them.

All the units, including the isolation and transplant ICUs, are tested for microbial growth and audited by the hospital's infection committee. Air flow and physical barriers are used to limit infection carried in the air.

• Critical care unit (CCU), 14 beds: critically ill patients of any speciality, including sepsis, respiratory failure, shock, severe asthma and COPD, poisoning, complications of pregnancy, liver failure, neurological emergencies and multi-system injury. One nurse for each patient.
• High dependency unit, 10 beds: close monitoring for patients who do not need full intensive care. Two nurses for every three patients.
• Surgical ICU (SICU), 18 beds, with a 16-bed step-down unit: patients after abdominal, cancer, gynaecological, chest, plastic, ear nose and throat, head and neck, orthopaedic and kidney transplant operations. Two nurses for every three patients.
• Intensive cardiac care unit (ICCU), 13 beds, with an 11-bed step-down unit: heart attack, heart failure and cardiac arrest, next to the cardiology and cardiothoracic surgery teams. Two nurses for every three patients.
• Cardiothoracic ICU (CT ICU), 11 beds, with a 6-bed step-down unit: recovery after heart and chest surgery, including bypass, valve repair and replacement, congenital heart surgery and aortic aneurysm repair. Two nurses for every three patients.
• Neonatal ICU (NICU), 5 beds: newborn babies who are critically ill or at high risk, and babies recovering and needing less intensive care, with neonatologists, paediatric intensivists and neonatal nurses. There is a breast pumping room and milk storage, a family room, and a mother and baby unit for rooming in.
• Transplant ICU: single rooms, for patients before and after liver, kidney, pancreas and heart transplantation, and for patients with liver failure, kidney failure, decompensated liver disease and heart and lung failure who need close monitoring.
• Isolation ICU: for patients who need to be nursed apart from others.

If you have been told you will need intensive care after an operation

This is planned and it is usual after major surgery. It does not mean anyone expects trouble. From theatre you go either to the post-anaesthesia care unit or straight to an intensive care bed, and you are watched closely while the anaesthetic wears off.

You may wake with a breathing tube still in place and be unable to speak for a few hours. You may not know what time of day it is, and you may remember little of it afterwards. Both are common and both pass.

Physiotherapy starts early, sometimes on the first day, because lying still brings its own problems. Once you are stable you move to a step-down unit and then to a ward.

Before the operation, ask your surgeon how many nights in intensive care they expect, and ask the guest relations executive to include those nights in your estimate.

What you can do that helps

• Bring the patient's medicine list, old reports and any discharge summaries. They save time and prevent mistakes.
• Tell the team about allergies, and about anything the patient takes that was not prescribed.
• Agree one family member as the contact, and keep one phone charged and answered.
• If the patient cannot speak for themselves, tell the doctors what they would have wanted.
• Speak to them when you visit, even if they do not answer.
• Eat, and sleep in shifts. This can go on longer than you expect.