There is a bevy of beeping machinery, miles and miles of tubes and numerous multidisciplinary health-care professionals busying themselves caring for about 15 critically ill patients at any given time.
It is a typical day in the Mount Sinai Hospital Intensive Care Unit – the ICU – although there is nothing typical about caring for critically ill patients.
The nightshift team of health-care professionals signs off, debriefs the oncoming day shift and a new day begins in the bustling ICU. The morning begins with an update from the night before, new patients admitted to the unit are discussed, while patients who are ready to leave the ICU are moved to more appropriate units for care. Patients are passed from the nightshift to the dayshift. Updates on other patients are also reviewed and then the daily rounds commence.
It is 8:30 a.m. Dr. Tom Stewart, Administrative Director of Critical Care at Mount Sinai Hospital and University Health Network, leads a team of medical residents through the ward, stopping at each patient’s bedside to evaluate their status and discuss the next steps in their care.
He encourages a collaborative team process and is empathic to the unique and special needs of his patients and their families, making every effort to ensure everyone is receiving the best medicine possible.
The demand for beds in the ICU is constant. By 9 a.m. the team is already preparing for the arrival of two new patients. Rooms are prepped with the proper equipment and the team stands-by awaiting the arrival of the new patients; one an elderly gentleman who requires extra care after the stress of surgery and the other an emergency department patient who has life-threatening pneumonia.
The care of ICU patients does not fall to one doctor or one nurse but rather to a multidisciplinary team of doctors, nurses, physiotherapists, respiratory therapists nutritionists, social workers, research coordinators and chaplains. All of them work together to develop care plans and keep families informed every step of the way.
“Teamwork is essential to patient care in the ICU,” said Dr. Tom Stewart. “Patients are usually critical for more than one reason, so having the expertise and input from all angles is crucial to providing the best and most effective care. That being said, it is very important that there is one final decision maker, who takes everyone’s opinion and rapidly makes the choice of direction.”
Rows of nurses in green scrubs line the corridors of the ICU. Outside each patient room sits a nurse who diligently monitors the patient and bridges the gap between patient and physician. The nurse to patient ratio in the ICU is one to one; nurses become a voice for their patient when they do not have a voice of their own. During the SARS emergency the nurse to patient ratio was increased to two to one for safety reasons, placing extra stress on ICU resources across Toronto.
Each nurse works a 12-hour shift assigned to the same patient. Nurses in the ICU not only treat their patients but also befriend their families. They quickly become a source of moral support, a listening ear or a shoulder to cry on.
“Being assigned to the same patient allows us to get to know them and their family beyond a clinical level,” said Steve Ramganesh, a Registered Nurse in the ICU. “We are there to treat them medically but we are also a form of support to them.”
Patients – most unaware of their surroundings – and their families are comforted by seeing a familiar face and knowing who is caring for their loved one. It also creates more effective channels of communication.
Patients are admitted to the ICU for a variety of reasons, but most often because one of their main systems, either cardiac or respiratory is failing. This could be accompanied by a myriad of other complications or issues arising from pre-existing medical conditions.
There is often so much going on with any given patient that care plans often involve a triage system that treats a patient based on the severity of their symptoms or condition. Long-term goals for patient outcomes vary from patient to patient depending on their condition but the ultimate goal for all patients in the ICU is for them to reach the point where critical care is no longer necessary. Dr. Tom Stewart explains that this is a realistic goal for 80 to 85 per cent of all ICU patients.
Recently, the ICU at Mount Sinai underwent renovations to increase the number of patient beds by three. This may not seem like a major expansion but in terms of enhancing patient care and the ability to accommodate more patients in need of critical care it will have a significant effect.
“It was important for us to have a larger ICU to enhance patient flow throughout the Hospital, and the critical care system overall,” said Dr. Stewart. “An efficient ICU saves lives and is an integral part of the hospital system.”