ICU - Intensive Care Unit

Head: Rudo L. Mathivha

Overview

The most exciting new development has been the opening of the High Care Area (HCA) in May. For several years the hospital has been lacking facilities for patients who do not require the full extent of ICU care (namely ventilation and continuous haemodialysis) but who do require closer monitoring than can be given in the busy general wards. This especially affected patients coming for major elective surgical procedures, as in the past such patients often had their operations delayed when all available Intensive Care beds were occupied. The Department of Surgery took the lead in assisting us with the provision of nursing staff to make the HCA a reality. At present up to eight patients can be accommodated in the HCA. The greater proportions of these are the post-operative patients admitted directly from theatre for post-operative fluid and pain management. In addition the HCA serves as a vital "step-down" facility for patients from ICU who are not quite ready for discharge to the wards. This frees up beds in the ICU for new critically ill patients. Patients in the HCA are looked after by the ICU consultant and medical officers on duty, and by specific HCA nursing teams. The inevitable teething problems made the first few months challenging, but the HCA is now proving its worth. The HCA is situated on the second floor of the ICU/Radiology building.

One floor down, the ICU "proper" continues to work under considerable strain. Limited numbers of nursing staff mean that only 12 to 16 beds are functional at any time. As these are the only intensive care beds available for all medical disciplines at CHBH (with the exception of neonates, burn victims and cardiac patients) it is not surprising that bed occupancy routinely exceeds ninety percent! The majority of the ICU patients require mechanical ventilation and inotropic support; it is also not uncommon to have five or more patients receiving continuous haemodialysis.

By its very nature, the care of critically ill patients is extremely stressful, especially on nursing staff, who are the most intimately involved with the patients. The unit is extremely fortunate to have such a dedicated corps of nursing staff, who give excellent patient care under intensely trying conditions. However, with the inevitable attrition, caused by retirement and resignation, the corps is shrinking, and with it the number of patients we are able to care for.

Statistics

Both the paediatric patients (past the neonatal period) and adult patients are accommodated. Figures from the year 2000 (during which around 750 patients were admitted to the ICU) show that just over 50% of adult admissions were trauma related, a reflection on the plague of traumatic injuries that continues to afflict our country.

Medical patients make up just under a third of total adult admissions, with obstetric and gynaecological admissions making up a significant minority. In the paediatric age group respiratory illnesses accounted for just below 50% of admissions, but trauma was still the cause of 10% of admissions.

Education

Education continues to be a high priority. Approximately 40 nursing sisters in training for the Critical Care Nursing Diploma rotate through the ICU each year.

Registrars from Anaesthesia, Internal Medicine, O&G and Surgery rotate through the Unit for 2 or 3 months at a time, and this time is recognised by both the College of Medicine of SA and the Health Professions Council of SA. In addition, the Unit currently has five Medical Officers on its staff. Registrars and Medical Officers are involved in the day-to-day care of both adult and paediatric patients. During their time here they gain valuable experience in managing ventilatory and inotropic support, the initiation and use of invasive monitoring, the supervision of haemodialysis and rational use of antibiotics and nutritional support.

An active teaching programme is in place, and registrars and MO's are supervised in the preparation of talks and presentations.

Furthermore, the Unit has received accreditation for Critical Care subspecialty training, and the junior consultants employed in the unit are working towards such accreditation.

Dr Rudo Mathivha, Director of the Unit, has, in the last year, received several invitations to lecture at international critical care conferences. In the past year the unit has also hosted several international undergraduate elective students, and continues to benefit from the presence of Dr Remy Toko, a consultant paediatrician from the Congo.

Research

On the research front, the Unit is involved in several international commercial drug trials. All funds accruing from such trials are returned to the Unit, and are in the main used to sponsor nursing, medical and allied medical staff to enable them to attend conferences.

Several academic research projects are currently in progress, with several more in the planning stage. The Unit strives to keep abreast of new technologies where theses can be of benefit to patients, and is currently one of very few non-neonatal ICU's in South Africa, which regularly uses a High Frequency Oscillatory Ventilator, a modality which is showing considerable promise in patients with severe respiratory compromise.

Our pharmacist, dietician and medical technologists are tireless in their efforts to keep the Unit up-to-date with developments in their respective fields.

The ICU takes its educational and patient care responsibilities very seriously, and staff continues to do their utmost to meet these needs despite ever-tightening financial and staffing constraints. While the opening of the HCA has helped greatly in allowing us to assist more patients than before, there are always more patients who would benefit from ICU care than can be accommodated. It remains our mission to identify those patients who would benefit most from the resources we can offer, and then to go all-out to give those patients the best care possible.

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