ITU care like a game of snakes and ladders

Eastbourne DGH ITU dept. Dr Rhian Edwards and staff. April 12th 2012 E15176N
Eastbourne DGH ITU dept. Dr Rhian Edwards and staff. April 12th 2012 E15176N

HELPING any patient is a difficult task. Having spent time in and around the DGH over the last few weeks what has really struck me is the hard work, dedication and professionalism of the hospital’s near army of doctors, nurses and other staff.

However, without belittling the amazing work done elsewhere – and much of it really is amazing – there cannot be a much more high stress and high stakes area of the hospital to work in than that of intensive care.

Dr Rhian Edwards is one of seven ITU consultants who are in charge of the unit, working on rotation one week in seven between 8am and 6pm each day.

They are joined by a trio of junior doctors and a legion of nurses, who spend most of their time working one to one with patients.

Bright and full of smiles, Dr Edwards does not give off the appearance of someone who spends her days dealing with life and death situations, faced by the most serious and difficult to treat conditions which come through the DGH doors.

Even when treatment can be appearing to go well, patients are not out of the woods. Not until they are out of the ward.

“Working on ITU can be a bit like snakes and ladders,” she revealed. Patients can be up a ladder one day and straight down a snake the next.

“Our survival rates are good, but obviously there are going to be times when people do not make it.

Mortality rates are higher than elsewhere in the hospital because of the nature of problems we are dealing with, but here at the DGH they are lower than the national average.

“That said, it is hard to lose someone.

“The nature of ITU is that staff, especially nurses, work very closely with patients – most of the time a nurse is at their bedside.

“It can make it difficult when a patient does not make it.”

And, just as staff get to know the patients, they also get close to families who, more often than not, are keen to keep a watch over their loved ones 24/7.

This, according to Dr Edwards, is where people skills come in.

“A lot of the time on ITU is spent talking to families, keeping them up to date with their relative’s progress,” she said.

“There is a lot of information to share with the relatives.

“That is where our nurses are so good. They spend time with the families, help them understand what is going on.

“They are with the person and their families all day every day. They really are brilliant.”

Supporting relatives is a key part of work on the unit, but providing a similar level of support to each other is almost as vital.

As Dr Edwards explained, “It [the work] can be taxing on an emotional level.

“Colleagues support each other and everyone has confidence in each others ability that they are all doing their best. We work together as an excellent team.”

And what a team it is.

There are eight beds on intensive care and while they are not all full every day of the year, in 2011 alone the unit helped treat 435 patients.

And, while some of these will be admitted as a result of planned surgery, more than 300 were non-scheduled medical admissions.

The average age of a patient was 59 years old, with the oldest aged 92 and the youngest just a few weeks old.

An average stay in ITU was a surprisingly short 5.3 days (with a median of 2.6) but as Dr Edwards explained, this did include some who will have had to stay ventilated and supported for anywhere up to 45 days.

Although Dr Edwards says the most common cause of admission to ITU is breathing problems, it is the sheer variety of complaints which keep her and her colleagues on their toes.

The level of expertise needed to keep someone alive on ITU, as well as the huge range of equipment often used on each patient, is made clear in the cost associated with it.

An average bed at the DGH costs about £250 a day to run. One on ITU is nearer £1,300.

“We are the most expensive department to run at the hospital so there is pressure on us to have the right number of beds.

“Our admissions are also variable. You do not know from one day to the next who will be coming in.

“You can have nobody one day and four the next, so it is difficult to calculate.

“But that variety is also one of the interesting things about working on ITU.

“You do need to know an awful lot about a wide range of conditions.

“It is what makes the work so rewarding.”