Critical care

Clinical lead

• Dr William Dean

Matron

• Trish Bivins

Service manager

• Elaine Wheeler

Clinical team managers

• Amy Wade
• Rachel Fenton
• Maria Fontes
• Bindu Panicker
• Claire Couch

Follow-up specialist nurse

• Esther Rawlinson

Professional development nurses

• Simone Hart
• Bruno Fernandes

Audit lead

• Susan Southwood

Clinical governance lead

• Dr Samantha Clayton

Critical care consultants

• Dr Kaushik Bhowmick
• Dr Vijay Gopal
• Dr Christiane Kubitzek
• Dr Claire Malcolm
• Dr Jeremy Mauger
• Dr Patricia Mills
• Dr Aditi Modi
• Dr Ben Pierce
• Dr Ayush Sinha

• Critical Care Family information
• Critical care follow up clinic
• Critical Care Information For Visitors
• Leaving critical care - going home
• Leaving critical care - going to the ward
  
  External information
• Recovery after critical care
• Sepsis a guide for patients and relatives
• The critical care follow-up clinic | The Faculty of Intensive Care Medicine

We look after patients who require continuous monitoring and treatment. Patients’ conditions can change quickly and can sometimes be life-threatening when they are admitted to critical care. Despite our best efforts, patients may become more unwell during their time on the unit.

There will be a lot of equipment and monitoring - this can appear quite daunting at first. This amount of equipment is quite normal in a critical care unit and the nurse will be happy to take the time to explain what each piece of equipment is used for if you would like to know more.

The bedside nurse can answer any initial questions you may have. You and your relatives will have regular opportunities to speak to the medical team regarding your condition. When possible, we will discuss all proposed treatments with you or your nominated next of kin. However, in some urgent circumstances this may not be possible, and we will act quickly with your best interests in mind.

We are committed to treating all patients with privacy and dignity in a safe, clean and comfortable environment. During a critical care admission requiring the use of specialist equipment, patients will be cared for in a mixed-sex open bay. Staff will always do their best to respect your privacy and dignity at all times.

During a Critical Care admission patients will be supported by a multidisciplinary team made up of a number of different healthcare professionals. Doctors, nurses, advanced critical care practitioners, physiotherapists, rehabilitation assistants, dieticians, pharmacists, occupational therapists and speech and language therapists, as well as our dedicated follow-up specialist nurse, may all be part of the team caring for you during your time on Critical Care.

You may need to be fed through a tube in your nose to your stomach or via a vein while you are critically unwell. This is because you require nutrition to help you get better. You may be too unwell to eat or drink for yourself or you may have been sedated. You will start to take food and drink normally by mouth as soon as you are well enough to.

After being unwell and having this feeding tube it is common for you to lose your appetite or for your taste buds to have changed. Many people find food tastes sweeter or saltier than normal. It should return to normal within a few weeks - during this time focus on eating foods that you enjoy. If you have a smaller appetite, eating little but more often may be a useful way to ensure you meet your daily dietary needs. Try having smaller meals with nourishing snacks in between. As your appetite returns, try to slowly build up your meal size and reduce your snacks throughout the day. Eating will be more enjoyable if you take your time, avoid heavy food and relax after a meal to help with digestion.

If your smaller appetite has been highlighted on the ward and you or the medical team are concerned you are not meeting your full nutritional needs, you will be referred to a dietitian.

Taking strong antibiotics and steroids can sometimes lead to infections, such as oral thrush. Oral thrush can result in a thick white substance coating the roof of your mouth and tongue, making it painful to swallow. If you think you might have thrush, your GP will be able to treat it easily.

If you are having problems with eating, drinking, oral thrush, returning to your normal weight, severe indigestion or persistent abnormal bowel movements please discuss this with your GP for further advice or onwards referral.

People remain in intensive care for varying lengths of time, depending on the extent of their illness and much of this time may be spent in bed. This can lead to muscle weakness, including the muscles used for sitting, standing, walking and breathing. Muscle wasting, skin sores, joint pain and stiffness (caused by lack of movement) are risks facing patients as they recover from a critical illness.

Physiotherapists will assess patients in critical care for breathing difficulties or coughing, using techniques to help bring up phlegm or to make breathing easier. There is substantial evidence that supports the role of physiotherapy for the respiratory management of critically ill patients, which has been demonstrated to provide both short-term and medium-term benefits. Physiotherapy treatment as part of a multi-disciplinary approach to care is integral in promoting lung function, reducing the incidence of ventilator-associated pneumonia, facilitating weaning from the ventilator, and promoting safe and early discharge from the intensive care unit.

Physiotherapists also aid physical recovery and early mobility following critical illness, encouraging patients to sit, stand with support and walk as early as possible. In addition, physios will teach specific exercises to be done at different times of the day and will support with the provision of this. Some people may also receive follow-up physiotherapy after a period of critical illness, to help people regain full fitness and may be invited to attend our FIT (following intensive therapy) group which is run with our follow-up Multidisciplinary Disciplinary Team.

Critical illness can impact individuals in a number of ways. For example, you may experience weakness, fatigue, emotional changes and/or changes in thinking skills.

Occupational therapy is about helping you to maintain or regain your functional independence. It aims to minimise deconditioning during your critical care stay, and optimise your functional recovery, as well as help you to adapt to any new needs that you may have at the point of discharge.

Occupational therapists in critical care may see you to support with:

• Managing fatigue
• Reviewing your cognition (thinking skills)
• Supporting your mood
• Oedema (swelling) management
• Positioning and seating
• Reviewing your upper limbs, and where appropriate provide activities or exercises to help with regaining strength and use of arms & hands
• Functional rehab – which may include practicing everyday tasks to help regain or maintain your ability to manage these (e.g. washing, dressing, grooming)
• Identify any equipment which may assist you with your recovery
• Discharge planning – to help determine what support, equipment or ongoing therapy that you need when you leave hospital, alongside yourself and your family/friends.

It is common for patients within critical care to experience a period of delirium, with some studies suggesting between 60-80% of patients will experience this at some point during their critical care stay. Delirium is another name for acute confusion. A patient with delirium may hallucinate, which means they can see, hear or feel things that don’t exist outside of their mind. They may also imagine they are in different situations - this can be very frightening.

These hallucinations and delusions may be incredibly realistic, and patients may be convinced that what they are experiencing in their mind is actually happening to them. This is often distressing for patients and very worrying for relatives. Delirium of this nature is usually temporary and will last from a few days to a week. Sometimes, however, it can last longer and may take several weeks to completely clear.

Critical care staff are very experienced at supporting patients through delirium and will have ways to support both the patient and their relatives.

More information can be found at: ICUsteps - Delirium and intensive care

Going to the ward is a change and for some people this can cause a degree of anxiety. You will only be moved to the ward when the critical care team feels you are well enough. They will let you know this before you go. The critical care doctors, nurses and therapists will hand over any information about you to the ward, so your care and rehabilitation is continued.

The daily routines, the staff and sounds are different. Other patients are likely to be well enough to talk to you, however some may be confused or noisy and this can be disturbing. As you get better, you will not need 1-on-1 observation. There will be fewer nurses on the ward to the number of patients, but they will still be checking your observations regularly and will be happy to help you if you press your call bell.

The process of recovery from critical care is not always easy. Going to the ward means you are becoming more independent. This can be hard work and very tiring. Learning to eat and swallow again, getting washed and dressed, and going to the toilet normally are far from trivial tasks. Setting small realistic goals with the rehabilitation team will help reach your target. They will also help you explore plans for going home.

Whilst on critical care, staff involved in your recovery and rehabilitation are likely to have included physiotherapists, occupational therapists, speech and language therapists as well as the nurses and doctors. They will have worked with you to improve your strength and mobility and will have set agreed goals for recovery.

When you are transferred to the ward your rehabilitation will continue with the therapy team responsible for that ward speciality.

The planning to get you out of hospital will start as soon as possible, with more emphasis when you are on the ward. So, when you feel able to, start thinking about where you might go when you are discharged. For example, this might be to your own home or to a family member or friend’s house. As you progress in your recovery you will be included in discussions about the appropriate time to be discharged home. If at that time you still have rehabilitation goals to work towards, you will be supported with any equipment required at home and have a referral to be followed up with community therapy teams. In some circumstances it may be more appropriate for you to continue your rehabilitation at a community therapy hospital to then facilitate your discharge home.

Examples of support may include:

• Equipment in the bathroom such as a raised toilet seat or perching stool to assist with personal care
• Progression of mobility from a walking frame to independence with the community physiotherapists.

We know that patients often cannot remember their stay in critical care. In order to help fill in some gaps, where possible, we will keep a patient diary during your stay. If you received a diary and you have any remaining questions about your time on critical care, please speak with the critical care follow-up specialist nurse.

We will invite you back to the critical care follow-up clinic if you have had a prolonged stay with us. The clinic offers you an opportunity to discuss your critical care stay.

An appointment is offered 2-3 months after you have been discharged home. If you have not received a follow up appointment and would like one, or you or your family have further questions, please contact the follow-up specialist nurse. Explanation will be given for the various physical or psychological changes you are experiencing, and support will be given to help you navigate these during your recovery. You are entitled to support for up to a year following discharge.

All patients in critical care are allowed visitors. We ask that you follow current Trust guidelines and respect our infection control procedures.

We have open visiting from 11am to 8pm. We ask that visiting takes place after 11am as this allows patient reviews and ward rounds to take place. This should also minimise times at which we may have to ask you to wait prior to being admitted to visit while patients are undergoing reviews or tests.

You can contact the unit via phone at anytime if you require an update. We ask that a single relative is nominated to undertake this role. You will be asked to set up a password and this should be used for all communication over the phone.

We value feedback from our patients and their loved ones. We review all feedback including themes from our patient surveys, clinics and follow up groups.

If you wish to, please complete the patient survey.