Admission of a patient to intensive care
Patients are admitted to an intensive care unit because they are suffering from an actual or potential life threatening condition. Although it is true most patients admitted are in a serious condition some patients are admitted as a precautionary measure. The intensive care unit (ICU) of a hospital fulfils different functions depending on the size and the services the hospital itself delivers. Today the role of the ICU is evolving with many units now catering for high dependency patients as well as the critically ill population. However for all patients the admission procedure remains more or less the same. What will be different between patients are length of time and the complexity of the admission procedures.
Getting an intensive care bed?
Intensive care beds are expensive to run and are limited in number even within the major teaching hospitals of Sydney. Patients will be admitted to ICU from a variety of sources including the emergency department, operating theatres and wards as well as from outside the hospital. Under most circumstances a doctor will identify the need for the patient be admitted to the ICU and will ring the intensive care staff asking them to review the patient. If the intensive care doctors agree that the patient needs to be in intensive care and there is a bed available the patient will normally be transferred to the ICU.
When the patient first arrives:
- They will be connected to the intensive care monitors and other equipment such as ventilators, BiPAP and infusion pumps.
- They will be thoroughly assessed to identify their condition and other problems. This will include a physical examination, blood tests and x-rays. It may be necessary for the staff to interview the next of kin for further information.
- Once assessed the intensive care staff will develop a plan of care and begin to implement this. At this point it may be possible to bring the family in to see the patient and for them to be able to ask questions of the staff.
- Patients who are critical and unstable may require immediate resuscitation and management.
- The timeframe for these admission procedures depends on the condition of the patient, the plan of care and the immediate treatment they require.
Plan of care
Over the next hours the plan of care will be implemented. This will include a combination of:
- Establishing monitoring of vital functions
- Such as the insertion of arterial, central lines , PiCCO or pulmonary artery catheters.
- Investigations to identify the extent of problems.
- This includes diagnostic tests such as blood tests, CXR and ECG. However more complex tests such as CT scans may be requird.
- Treatment to support organs:
- Lungs – BiPAP or intubation (insertion of a breathing tube or ETT) and ventilation.
- Heart – medications for shock or insertion of an intra aortic balloon pump.
- Kidneys – commencing dialysis.
- Procedures or surgery
- Such as the insertion of chest drains or surgery to stop bleeding or relieve pressure on the brain.
The plan of care will be amended as the patient's condition changes and new information is received.
When can Visitors come in?
Visitors are generally admitted at the earliest opportunity however on occasion this may be several hours. Whilst communicating with the visitors is seen as important the medical priority is stabilising the patient’s condition. Social worker services and/or pastoral care workers are available at a number of hospitals, including after-hours in some of the larger hospitals. Social workers can act as a liaison between ICU staff and provide visitors with updated information on the condition of the patient. Social workers are trained to assist people in crisis and can provide information on issues such as accommodation and where to eat. They may also be able to assist with legal and financial issues. Reversal of social worker assistance early on does not mean that these important services cannot be accessed at a later time. Please refer to the visiting policy in your Intensive care for further explanations.
Admission Procedures Version 1 first published July 2006 (Author K Rolls CNC ICCMU)
The information contained on this page is general in nature and therefore cannot reflect individual patient variation. In addition it reflects Australian intensive care practice which may differ from other countries. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. ICCMU attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.
Last Updated on Friday, 18 February 2011 15:13