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Tim Meekings reports on the new ITU at NGH which is now open. As of Friday 14/03/08 it was open to 11 ITU beds. This was supposed to have gone up to 13 on 10/3/08 but was limited due to insufficient Nursing Staff. The final total will be 18 ITU beds and 18 beds split between HDU and POSU. There are changes to the staffing structure and cover of ITU so read on for details...
There are two 4 bedded bays and 3 side rooms currently in use. There are pendants for the monitoring and syringe drivers to be mounted on, a bit like Cardiac ITU, so this reduces the clutter round the bed space. The ventilator slides in beneath the pendant so is fairly tucked out of the way.
All the monitoring is new too, touch screen and with a matching little transport monitor which can be used for tranfers to CT etc., the tram module can be transferred between the main monitor and protable one without losing data or having to re-zero (again, this is similar to Cardiac). Every bed space has a flat screen telly mounted on the wall in the patient's view - obviously the nurses are mainly benefiting from this so far.
The daily running of the unit is pretty much unchanged so far, though the layout makes it easy to divide into teams to see the patients and look after them during the day. There are plans afoot to maybe move the ward round into the morning and/or make it a sit down affair in the seminar room. This is contingent upon installation of Metavision (similar to RHH) which I think is June/July time. PACS is up and running with a big monitor in each of the bays. Every side room also has a computer in, which can display PACS images (and you can log on to PFI system and the internet etc. too!). When Metavision comes in, each bedspace in the bays will also have a computer.
As from August, "B on call" is no longer staffed by an Anaesthetist. We have Acute Care Common Stem doctors starting - this will be their first block (i.e. will not have done the year of Acute Medicine/A & E, but may have done jobs like POSU during F2 year). This has big implications as all pain calls will go to theatre team as obviously a non-anaesthetist cannot deal with them. As for calls to Resus for combative/low GCS patients, the Acute Care Common stem trainee will obviously need a lot of help - by day this will probably be the HDU consultant but out of hours, the ITU team will have to be involved.
The ITU staffing has already changed - we have 5 clinical fellows from Czech Republic/Bulgaria that have joined us (all Anaesthetists). Along with Advanced Trainees (me and Aung, an Acute Medicine SpR), a new tier of the rota has been formed, so out of hours, ITU now has the Anaesthetic SpR plus the Clinical Fellow/Advanced Trainee. At the moment, this is a slight luxury for 11 patients, but as we head towards 18 patients PLUS lose an anesthetic trainee as "B" in August, this will get busier. The other change is that RHH consultants are now coming across to do day shifts as well as the on-call, they are coming on to ITU and also HDU. Upstairs on the HDU floor there are 6 HDU beds and I think 7 POSU beds (POSU SHO to cover POSU patients).
Tim Meekings
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