4 East Surgical Intensive Care Unit
Description of Unit
The 4EAST Surgical 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.
Description of Patient Populations
Patients are admitted to 4EAST Surgical Intensive Care (SICU) from the Operating Room, Emergency Department, and/or general floor for continued cardiovascular, respiratory, postoperatively following moderate to complex surgical procedures, from the Emergency Department, as a surgical referral from another hospital, or preoperatively for evaluation and treatment. Patients admitted to 4EAST 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 thoracic oncology, breast oncology, various sarcomas, endocrinology, pancreas & biliary surgeries and transplants, and minimally invasive GES surgery, urology, gynecological and colorectal.
Patients admitted to 4 EAST IMC require monitoring and/or interventional therapy at intervals ranging between 2 to 3 hours. The general surgical population includes patients’ status post abdominal resections, gastrointestinal bleeds/repairs and liver/kidney transplants. Other common surgical populations requiring 4 EAST IMC postoperative care include: abdominal aortic aneurysm repair, liver, and peritoneal resection. Surgical adolescent, adult and geriatric patients are the acceptable patient population. The average length of stay is 2 -3 days.
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, 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 anesthesia/critical care medicine. The Critical Care Medicine 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 4EAST 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 support techs.
Registered nurses on 4EAST 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.