The 4 West Surgical/ Trauma Intensive Care Unit is a 24-bed inpatient unit located on the fourth floor in the Cancer Tower Building. The unit consists of twenty-four private rooms with monitoring capabilities at each bedside. There are four 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 4 West Surgical/ Trauma Intensive Care from the Operating Room, Emergency Department, other ICU or Med-Surg floors, as well as from outside hospitals. These patients require continuous cardiovascular and respiratory monitoring and care, as well as postoperative care following moderate to complex surgical procedures. Patients admitted to 4 West STICU require monitoring and/or interventional therapy at intervals ranging between 1 to 2 hours. Patients admitted to 4 West IMC require monitoring and/or interventional therapy at intervals ranging between 2 to 4 hours. The surgical population includes patients who are status post-surgical procedures including exploratory laparotomy, small bowel resections, partial and total colectomy, wound debridement for necrotizing fasciitis, ostomy and fistula takedowns, ortho oncology large tumor resections, neurological and orthopedic trauma. Special populations include sepsis and Acute Respiratory Distress Syndrome, both of which are identified and cared for with protocols and decision support algorithms. Adolescents of greater than 40 kilograms, small adults greater 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, 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, advanced practitioners, 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 4 West STICU 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/support techs.
Registered nurses on 4 West STICU 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.
Nursing care on 4 West STICU is based on the total patient care delivery model (as described in the Hospital Plan for Nursing Care) with coworker assistance. Support Tech coverage is available 24 hours a day. Skill mix is 100% RN; no assistive staff. The predominant staffing ratio of nurses to patients is 1:2. Occasional changes in ratios, either 1:1 or 1:3 ratios, are accommodated based on the prescribed level of care and ongoing needs of the patient. 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 requirements
- Continuity of care needs
- Procedures at the bedside (trachs, G/J tubes, central lines, A-line, ventriculostomy, etc.)
Additional staffing needs are met on 4 West STICU 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 12 registered nurses and 2 support techs/12-hour shift.