4 West Surgical/Trauma Intensive Care Unit
Description of Unit
The 4WEST Surgical/Trauma Intensive Care Unit is a 24-bed inpatient unit located on the fourth floor in the Cancer Tower Services Building. The unit consists of twenty-four private rooms with monitoring capabilities at each bedside. There are two negative laminar airflow isolation rooms available. All bed spaces are equipped with hard-wiring at the bedside and remote alarm capability (monitor and ventilator) to the central nursing station and nursing alcoves. Monitoring capabilities include continuous 5-lead electrocardiogram, pulse oximetry, capnography, invasive and non-invasive hemodynamics. The patients are not segregated to an area based on ICU or IMC level of care. Care is provided 24 hours per day, 7 days per week. Average bed occupancy is to be determined.
Description of Patient Populations
Patients are admitted to 4WEST Surgical/Trauma Intensive Care from the Operating Room, Emergency Department, and/or general floor for continued cardiovascular, respiratory, postoperatively following moderate to complex surgical procedures for monitoring, from the Emergency Department, as a trauma or vascular referral from another hospital. Patients admitted to 4WEST SICU require monitoring and/or interventional therapy at intervals ranging between 1 to 2 hours. The surgical population includes patients status post surgical procedures and include Ortho oncology, Ortho, emergent exploratory laporotomy and vascular ( AAA, TEVAR ,etc). Adolescents of greater than 40 kilograms, small adults less than 40 kg, young, middle-aged, and older adults are admitted to the unit. The average length of stay is 1.0 for IMC and 4.56 for ICU.
Patients admitted to 4 WEST IMC, require monitoring and/or interventional therapy at intervals ranging between 2 to 3 hours. The general surgical population includes patients’ status post emergent abdominal resections, gastrointestinal bleeds/repairs. Other common surgical populations requiring 4 WEST IMC postoperative care include: vascular procedures, hemipelvectomy, total hip replacement, and other orthopedic procedures. Adolescents of greater than 40 kilograms, small adults less than 40 kg, young, middle-aged, and older adults are admitted to the unit.
Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of patients requiring intensive and intermediate care. Nursing activities include hemodynamic (arterial, central venous pressure, pulmonary artery pressures, intra-abdominal pressures, arterial/venous oxygenation, and capnography monitoring, fluid and electrolyte monitoring, ICP, PbtO2, Brain temperature, vasoactive and inotropic therapy, respiratory management in both the mechanically-ventilated and spontaneously-breathing patient, CVVH, massive volume resuscitation, bispectral index, burst suppression ratios, and peripheral nerve stimulation for neuromuscular blockade, postoperative recovery, specialized wound care, nutritional therapy, medication management, and comfort/sedation measures as indicated. Patient and family education and emotional support related to the patient’s condition and treatment is an essential element in the nursing care provided.
Health Care team
The Critical Care Medicine medical director is board certified in anesthesiology/critical care medicine. The Critical Care Medicine unit faculty, fellows, and residents in conjunction with the patient’s Surgical Service faculty, fellows, and residents provide 24-hour care, 7 days per week for the 4WEST SICU surgical patient. Multidisciplinary, comprehensive care of these patients and families is provided by medicine, nursing, respiratory therapy, pharmacy, social work services, case management, pastoral care, food & nutritional services, rehab services, and other health care providers as indicated by the patient’s health status and identified needs.
The nursing management for the unit includes a registered nurse in the position of Nurse Manager and a registered nurse in the position of the Clinical Leader. Unit staff includes registered nurses and unit clerks.
Registered nurses on 4WEST SICU meet the basic requirements for Registered Nurse staff and function in accordance with the unit-based job description, as described in the Hospital Plan for Nursing Care. Additional unit requirements for registered nurses include a positive attitude toward family-centered care and open visitation, and the ability, willingness, and interest to work with the age-appropriate needs of patients.
Support techs meet the basic requirements for their positions and function in accordance with their unit-based job description, as described in the Hospital Plan for Nursing Care. Additional unit requirements for the support techs include having a positive attitude toward family-centered care.