The 4EAST Surgical Intensive Care Unit is a 24-bed inpatient unit located on the fourth floor in the South Cancer Services Tower. The unit consists of twenty-four private rooms with bedside monitoring, bedside computer documentation, and barcode scanning capabilities for lab and medications. There are four negative laminar airflow isolation rooms and two bariatric equipped rooms available.
All bed spaces are equipped with hard-wiring clinical monitoring with central remote alarm capability (patient monitors and ventilators) to the nursing station and adjacent nursing alcoves. Bedside monitoring capabilities include continuous 5-lead electrocardiogram, pulse oximetry, capnography, and invasive/ non-invasive hemodynamics and BIS monitoring. The patients are not segregated to an area based on acuity or level of care and remain in the same room regardless of ICU or Intermediate 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) following moderate to complex surgical procedures, as a surgical referral from outlying hospitals, or preoperatively for evaluation and treatment. Patients may also transfer from the Emergency Department, procedural areas and from the general floor when increased need for continuous cardiovascular, respiratory, or other acute intervention arises. Patients are admitted to 4EAST SICU or IMC depending on their requirements for monitoring and/or interventional therapy. Intensive (SICU) admissions require interventions ranging less than every 1 to 2 hours and patients admitted to 4 EAST IMC require monitoring and/or interventional therapy at intervals ranging between 2 to 4 hours.
The surgical patient populations include post-surgical procedures pertaining to a variety of specialty services including but not limited to the following: esophageal and gastrointestinal oncology, breast oncology, various sarcomas, endocrinology, pancreas & biliary surgeries, solid organ transplantation, minimally invasive gastroesophageal surgery, urology, gynecological, and colorectal. The general surgical population may also include patients’ status post abdominal resection, gastrointestinal bleeds or repair, and liver or peritoneal resection. Surgical adolescent, adult and geriatric patients are the acceptable age specific patient populations for admission. Patients may be treated for a variety of comorbidities in addition to their acute states. Often interventions focus on patients in states of septic, hypovolemic, hemorrhagic and/or occasional cardiogenic shock. The average length of stay is 3-4 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, CRRT, massive volume resuscitation, bispectral index, hTee, 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. Family engagement is highly encouraged during bedside handoff report and during interdisciplinary patient rounds.
Health Care Team
The Surgical Critical Care (SCC) medical director is a trauma surgeon, board certified in critical care medicine. The SCC 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 patients admitted to 4EAST SICU. Multidisciplinary, comprehensive care of these patients and families is provided by medicine, nursing, respiratory therapy, pharmacy, social services, case management, pastoral care, food & nutritional services, rehab services, and other health care providers as indicated by the patient’s health status, comorbidities, chronic and acutely identified needs.
The nursing management team for the unit includes a Master’s prepared Nurse Manager and Clinical Leader. A Unit Assistant helps support the work flow of the unit. Unit staff include registered nurses and unit support techs.
Registered nurses on 4EAST SICU not only meet the basic requirements for Registered Nurse licensure, but they must also 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 and hospitable attitude that contributes toward a healthy work environment among colleagues and a patient centered, family-oriented atmosphere that welcomes visitation that contributes to healing. Nurses are required to obtain Bachelor Degrees in nursing upon hire, and national certification is highly encouraged and expected after requirements are substantiated. Education expenses are supported financially by the institution.
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 displayed in a healthy work environment.
4East SICU staffing is based upon budgeted nursing hours per patient day (HPPD) which is formulated using national benchmarks and historical unit acuity data. Daily staffing is adjusted based on unit census and feedback from charge nurses to account for special circumstances that increase patient acuity, such as the need for a sitter, increased number of 1:1 patients, etc.
Nursing care on 4EAST SICU is based on the total patient care delivery model (as described in the Hospital Plan for Nursing Care) with coworker and teamwork assistance. Support tech coverage is available 24 hours a day. Skill mix is 100% RN with no clinical assistive staff. The predominant staffing ratio of nurses to patients is 1:2. Occasional changes in ratios, either 1:1 or 1:3 are accommodated based on the prescribed level of care and ongoing acuity needs of the patient. The staffing plan is based on 17.56 total HPPD and 5.88 HPWI.
Patient care assignments are made each shift by the Charge Nurse, as described in the Hospital Plan for Nursing Care. Additional unit-based considerations for staffing needs include:
- Impact of complex family/social situations
- Off-unit and bedside requirements for procedures which may include assistance and transport of the patient to procedural areas.
- Continuity of care needs
- Experience and competency level of RN staff assigned
Additional staffing needs are met on 4EAST SICU as described in the Hospital Plan for Nursing Care. The need for extra shifts/overtime is determined by the Nurse Manager or designee, in accordance with the Hospital Plan for Nursing Care.
Requests for scheduled time off (STO) will be reviewed on a case by case basis and will take into account the staffing needs of the unit. Requests are granted only if minimum staffing numbers are maintained with coverage that does not incur overtime.
Staff attendance at meetings, education offerings, and other activities are coordinated so that patient care coverage is continuous, as reflected on the shift assignment sheets.
In the event of an emergency such as severe weather conditions or other disaster, the minimum amount of staff required to safely operate up to 75% capacity would be 14 and registered nurses and 3 support techs for days and 14 RNs and 2 STs for nights.