Intensive Care Units or ICUs in Hospitals evoke mixed responses from people. While some patients and families express concern over the costs, many patients acknowledge the high level of care and specialist treatment that ICUs offer.
ICUs are increasingly discussed in recent years, yet, ICUs have a long history. Legendary nurse Florence Nightingale wrote about having a separate specialized unit to care for patients recovering from surgery, as early as the mid-19th century. But the real credit for formally establishing an ICU goes to Dr. W.E Dandy of the John Hopkins Hospital, Baltimore, USA, in 1927. During World War II and the polio epidemic of late 1940s, ICUs started becoming a common feature in American hospitals.
ICUs are indispensable
Between the 1950s and 1990s, ICUs or CCUs (Critical Care Units) were largely used to care for premature babies, very sick patients and those with post-surgical complications. But since the 1990s, advancements in Medicine and Healthcare combined with newer diseases being diagnosed, has created a compelling need for ICUs.
- Patients with cerebro-vascular complications and tumours such as that of the lung, require specialized care. Admitting them in the ICU reduces time spent in the hospital.
- Transplantation of various organs requires a lot of post-operative monitoring and intensive care, which is best provided in an ICU. Not having an ICU can increase mortality rate and failure of the transplant.
- The use of minimally invasive procedures followed by intensive care in an ICU accelerates rehabilitation in patients with medical or nursing complications.
- The use of specialized medicine combined with intensive care has helped patients with single or multiple organ failure recuperate faster.
- Increased cases of trauma, such as those from accidents, stab-wounds, gun-shot wounds, falls from heights and severe burns require specialized care
Benefits provided by an ICU/CCU
In the US, the Leapfrog Group along with the Society for Critical Care Medicine (SCCM) published guidelines for regulating the functioning of ICUs, and since then has been documenting the benefits ICU/CCUs bring, based on real cases. As per the same, ICUs/CCUs accomplish the following (source: National Centre for Biotechnology Information (NCBI))
- Reduced Mortality rates
- Shorter ICU stay
- Shorter duration of mechanical ventilation
- Reduced arrythmias and hypotensive episodes
- Lesser incidence of renal failure
- Increased number of central venous and pulmonary artery catheterizations
- Reduced number of arterial blood-gas analyses
- Fewer consultations required
- Reduced ICU costs
- Specialized Education for ICUs
Specialized Education for ICU/CCU
Considering the necessity and benefits of an ICU/CCU, regulatory bodies like the Society for Critical Care Medicine (SCCM) in the US and the Medical Council of India (MCI) In India have deigned courses to develop doctors who are specialized in Intensive Care, called Intensivists. Indian Society of Critical Care Medicine (ISCCM) offers courses such as IDCCM and IFCCM for this branch of medicine that is now considered a super-speciality.
Members of a Critical Care Team
A Critical Care team is a multidisciplinary team made up of specialists with training in a specific branch of medicine combined with specialization or training in intensive care.
- Intensivist or CC specialist: Intensivists have a board specialization in a branch of medicine, and a certification in Intensive care. An intensivist is a full-time specialist assigned to a ICU/CCU and is aware how various treatments affects organ systems. He/she avoids duplication of effort and knows the patient or family’s preferences. He also acts as a single point of contact for other members of the team, the primary physician, the patient and family members.
- Critical Care Nurses: CC Nurses are either very experienced senior nurses or mid-level nurses with training in intensive care. They closely monitor the patient’s condition, know when to make necessary interventions and act as a link between the patient and his/her family.
- Clinical Pharmacologist: A pharmacist with training in Intensive care. He/she works closely with the Intensivist and other members of the team to design medication therapies.
- Registered Dietician: The dietician who works with the ICU/CCU takes care of the special nutritional needs of the ICU patient which is different from other patients.
- Respiratory Therapist: he/she monitors the patient’s airway and undertakes oxygen-therapy, mechanical ventilation, cardio-respiratory monitoring and aerosol medication therapy, as required
- Occupational or Physio-therapist: He/she relives pain, restores function, improves mobility of the patient, and offers counselling in order to reduce physical or psychological disability of the patient.
Our experience with ICU/CCU
Kauvery Hospital maintains a CCU in all its branches across Tamil Nadu. The expertise behind the intensive care and our friendly, empathetic approach towards patients or their family members has been highly appreciated by them, time and again.
- Admission: The Emergency Unit admits patients for surgery even as friends or family members are completing the admission procedures. No advance payments are collected and all payments are made only during discharge.
- Post-operative care: Members of the CC team as well as the patient coordinator attends to the patient and family members, constantly updating them on the condition, treatment being meted out, expected outcomes, etc.
In recent years, doctors and hospitals have been educating patients and family members on the cost and healthcare benefits of a CCU, to negate wrong perceptions around ICU/CCU. Needless to say, ICUs/CCUs add a lot of value and take patient-care to a higher level.