St. Mary’s New Chest Unit Enhances Patient Care

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St. Mary’s General Hospital’s (Kitchener, Ontario) Chest Unit provides specialized patient care and enables more efficient use of critical care resources. The unit, opened February 2004, has 27 beds and three negative-pressure isolation rooms. This unit fulfills our strategic direction to develop an area of excellence in respiratory and thoracic care. When creating this unit St. Mary’s considered which patients would benefit, what needs could be met, and whether we could provide something unique to improve patient care.

The consolidated in-patient care area groups persons with acute and acute-on-chronic respiratory diseases, previously admitted throughout the hospital. As well, persons undergoing thoracic surgery are admitted to the Chest Unit postoperatively. It is innovative to have a unit that cohorts both thoracic surgery and respiratory medicine patients in a combined ward, the benefit being the ability to specialize in and consolidate the common expertise required for care. A respirologist or thoracic surgeon is the most responsible physician within this unit, and registered nurses and an increased presence of registered respiratory therapists support the unit.

“Having a dedicated chest unit gives us the ability to group patients, as well as the nursing and allied health staff, and create a focus of expertise in the staff. This promotes a consistency of evidence-based care, which ultimately benefits the patient,” says Dr. Eric Hentschel, Medical Director, Chest Unit.

The Chest Unit team is comprised of: respirologists, thoracic surgeons, RNs, advance practice nurses, registered respiratory therapists (RRTs), physiotherapists, occupational therapists, pharmacists, clinical nutritionists, social workers, members of spiritual care and volunteers.

In addition to regular unit orientation, RNs in this dedicated area receive additional classroom education geared towards the pulmonary and thoracic system. Co-ordinated by Terry Boshart, Clinical Nurse Educator, this extra training includes such topics as: pulmonary and thoracic assessment, pulmonary pathologies, the use of BiPAP (non-invasive positive pressure ventilation), intra-pleural analgesic, epidural management, cardiac monitoring, and care of chest tubes. Ongoing education is facilitated for all staff and includes intra-disciplinary teaching rounds led by a respirologist. St. Mary’s also employs an Advance Practice Nurse for Respirology, Suzy Young, who supports the clinical management of patients and also works closely with staff to develop their expertise in respiratory assessment and care.

“We are really lucky to receive this extra training, and it’s exciting,” says Rosemary Grominsky, RN. “The education and support is readily available and wonderful.”

“We are excited to have our patients in a clinically focused area. The team is able to build on their collective expertise at a time when this patient population has been recognized to be growing substantially,” says Hentschel.

The four-bed intermediate care area is a highlight of our new unit. This area has cardiac monitoring and the ability to monitorÊpatients on BiPAP. It also accommodates those thoracic and respiratory patients who require closer observation and monitoring by nursing staff.

The use of BiPAP in the intermediate care area is unique for a non-intensive care unit and it is the optimal treatment for some respiratory patients. Eligible patients benefit from non-invasive treatment for various types of respiratory failure. Patient monitoring of BiPAP is facilitated by the RNs and RRTs and has proven effective in minimizing patient movement from the ICU or preventing transfer to an ICU bed for this monitoring. Persons that decline intubation but would like to attempt BiPAP no longer need to be transferred to ICU for care. It is suggested that the use of BiPAP reduces morbidity and mortality, reduces the risk of pneumonia and shortens patient length of stay, when compared with intubation and ventilation.

The three negative-pressure isolation rooms are used for airborne respiratory diseases such as TB, and SARS-like illness. The isolation rooms are complementary to the Chest Program and support and enhance the care provided. Having these rooms is reflective of the enhanced respiratory precautions and standards, post-SARS.

“It’s great to be a part of this unit,” says Young. “It enables us to care for patients more effectively and comprehensively. Having all these respiratory resources in one area benefits everyone.”

By managing a dedicated Chest Unit at St. Mary’s, we minimize patient transfers, increase the continuity of care and facilitate increased efficiency in the use of our intensive care resources. Our Chest Unit also allows staff to develop a focus of expertise in their care delivery. This new unit provides an area of excellence for respiratory and thoracic care to the community at a time when it is highly needed, and this enables us to offer better patient care overall.

For more information about our new Chest Unit please contact Sandra Rains, Assistant Vice President, Patient Services, at srains@smgh.ca