The ICU "proper" continues to work under considerable strain. 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.
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 the country.
Medical patients made 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 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.
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.
A 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 to assist more patients than before, there are always more patients who would benefit from ICU care than can be accommodated.