The critical care programs at London Health Sciences Centre's University Hospital consists of 38 critical care beds. The Medical-Surgical ICU (MSICU) specializes in the care of neurosurgery, transplant and general medical/surgical patients. The Cardiac Surgery Recovery Unit (CSRU) cares for patients post cardiac surgery.
Patient care is provided by a multidisciplinary team including:
The members of the Allied Health disciplines are essential to patient care in the MSICU and CSRU.
- Respiratory therapists: the respiratory therapy department covers the units on a 24-hour basis as well as covering the rest of the hospital.
- a social worker covers the unit Monday to Friday and provides support to families, patients and staff.
- Physiotherapists provide prevention and treatment to patients for problems related to critical illness and immobility such as range of motion exercises and other exercises to help keep the lungs clear. They also help 'mobilize' patients by helping them sit, stand, and walk as they recover.
- a registered dietitian manages the unique dietary needs of patients in critical care. The dietitian carefully monitors patients' lab results and response to their diet and provides nutritional therapy to patients.
- a pharmacist provides information about specialized critical care drugs.
The site chief for the Medical-Surgical ICU and Cardiac Surgery Recovery Unit is Dr. Ron Butler.
Medical-Surgical ICU Team
The Medical-Surgical ICU (MSICU) medical team consists of a group of nine consultants in critical care medicine with anesthesia, respirology, surgery and endocrinology specialty backgrounds.
The call coverage is a first and second call model, with first call covering the 19 teaching beds and the second covering the five non-teaching Extended Intensive Care Unit (EICU) beds. The first call is a day/night schedule; day covers Monday to Friday daytime and picks up EICU over the weekend. Also on the weekend, this physician covers 24/7, on unit in the daytime and on call overnight. The consultant covering nights works Monday to Friday opposite the day consultant. These consultants may also cover for the Critical Care Outreach Team (CCOT) while on night call or second call.
Cardiac Surgery Recovery Unit Team
The 12 Cardiac Surgery Recovery Unit (CSRU) consultants are from three specialties: critical care medicine, cardiac surgery and cardiac anesthesia. Several of these consultants also cover MSICU or Critical Care Trauma Centre (CCTC) at Victoria Hospital. The call is a day/night model Monday-Thursday. Friday to Sunday the day consultant covers 24 hours a day.
The resident schedule is a senior and junior in-house call model. The MSICU has 1 - 3 senior residents on their own call schedule. Five to eight junior residents rotate through a schedule of in-house call. The CSRU has two senior residents rotating a day/night call schedule.
Critical Care Outreach Team Coverage
24-hour Critical Care Outreach Team (CCOT) coverage involves the MSICU consultant in-house from 8 a.m. to 5 p.m. and available by phone after hours. The nurse assigned to CCOT works a 12-hour shift with a respiratory therapist.
Staff Nurse Structure
The nursing structure of the MSICU/CSRU is special as it is one of the few remaining critical care units in Canada that uses a shared staffing model. Nursing staff are all registered nurses. Nurses rotate between the MSICU and the CSRU for four weeks in each area, with flexibility to move between the two areas as patient need dictates. 70% work a full-time rotation of a two-day, two-night with five scheduled shifts off rotation. 20% of the staff are casual (relief) nurses assigned only to critical care. 10% are in job share or part-time rotations.
The variety of patient populations they care for allows them to maintain all of their critical care skills (instead of focusing in only one skill set) and provides a stimulating environment. There are over 200 nurses working in the units. Staffing is generally 1:1 or 1:2 as patient acuity dictates.
Other Nursing Roles
The clinical nurse specialist (CNS) focuses on providing continuity and consistency in the plan of care for patients, families, and MSICU staff. She also coordinates transfer and discharge planning for long term stay patients in Bay 6 of the MSICU.
The nurse practioner (NP) in the CSRU is responsible for assessing patients and managing complex patient situations providing support and direction to other CSRU team members. The NP generally works Monday to Friday and provides continuity of care to CSRU patients and their families.
There are seven dedicated full-time charge nurses who follow the same rotation as the nursing staff. They are supplemented by an in-charge group from the RN's. 24/7 charge nurse coverage is provided for both the MSICU and CSRU.
There is a patient care manager who oversees both units. The MSICU and CSRU also have two nursing coordinators and two clinical educators on staff who provide nursing education, including orientation and continuing education.