East of England Critical Care Operational Delivery Network

eoeccn.org.uk

Critical Care Explained

Critical Care is a term now used for an area in the hospital, which provides two levels of care for patients, although in some hospitals this may be in two separate areas. These patients will be the sickest patients in the hospital from a severe illness or injury. The aim is to achieve the best possible recovery, although this is not always possible and because they are so ill, some patients will die in Critical Care. When recovery becomes impossible the focus of care changes to making the patient as comfortable as possible. The two levels of care are:

Level 3

Level 2

Intensive Care or Level 3 patients

These are patients who would have been cared for in an Intensive Care Unit (ICU) sometimes called an Intensive Therapy Unit (ITU). These patients will receive specialist monitoring and equipment to take over the work of one or more of their body's organs such as breathing or the work of the kidneys. There is a nurse allocated to care for each patient 24 hours a day (1:1 nurse:patient).

High Dependency or Level 2 patients

These are patients who would have been cared for in a High Dependency Unit (HDU). These patients require a level of care between intensive therapy and the general hospital wards. Examples would be patients who no longer need intensive therapy but need step-down care or patients admitted from wards, Accident and Emergency (A&E) or Theatres to prevent them requiring intensive therapy. Although the equipment is the same, most patients need less specialist equipment and the nursing ratio is one nurse to every two patients, 24 hours a day (1:2 nurse:patients).

The Critical Care Experience

Patients in Critical Care need constant medical support to keep their body functions going. They may not be able to breathe on their own, and may have multiple organ failure, so medical equipment takes the place of these functions while they recover.

Being in Critical Care can be a daunting experience both for the patient and his or her family and friends but the staff understand this and are there to help and support both patients and their families during a difficult time. Explanations of the staff and equipment can be found in the booklet ‘Intensive Care, a guide for patients and relatives’

Moving Patients Between Hospitals

Critical Care beds are a very expensive and limited resource because they provide specialised monitoring equipment, a high degree of medical expertise and constant access to highly trained nurses. If all the beds in a particular hospital are full, and everything possible has been tried to create a bed, then doctors will look for a bed in another hospital. Patients sometimes need to move to other hospitals for specialised treatments and then later return back to their home hospital. The transfer is by ambulance with a Critical Care Doctor, Nurse, Ambulance crew and all the equipment.  Part of the function of the East of England Critical Care Operational Delivery Network is to support the hospitals in making the organisation of their transfers run smoothly.