Reasons for admission
- People are admitted to critical care units because they need constant, close monitoring and support from health professionals, equipment and medication to maintain normal bodily functions. Admission to the MSICU may be planned – often following major surgery, or unplanned due to the development of sudden critical illness. Critical illness is often unexpected, and can strike the previously fit as well as the frail. It can be life threatening and high levels of treatment and support may be needed, especially in the early stages. Patients remain in intensive care for varying lengths of time, depending on the nature of the illness, and receive a high level of nursing care, continuous monitoring and specialized treatments that cannot be provided in other areas of the hospital.
A day in the MSICU
Nursing change of shift
Nurses sign out to the oncoming nurse, exchanging important patient information. The change of shift happens at 7h30, 15h30, 19h30 and 23h30.
Physicians, nurses, and other members of the multidisciplinary team formally evaluates the patient twice a day to discuss the care and the treatment plan for your loved one. The main rounds occur in the morning, around 8 am – this is generally when the plan for the day is established. Family presence on rounds is encouraged and allows family members to better understand the medical issues and treatment plans. Unfortunately, it is difficult to predict when the team will arrive at you loved one’s bedside. There is a second, brief, rounds that occurs at the end of the day around 4 pm. These “sign-out rounds” are designed to ensure that the on-call team has a good understanding of the patients’ condition and a plan for the night. During the day the medical team is present in the MSICU to continually monitor, re-evaluate and treat patients as needed.
These rounds occur every Monday afternoon. It is an opportunity for all members of the multidisciplinary team to receive and provide updates on the condition and progress of your loved one and make a collaborative plan that complements other interventions being offered.
Some procedures or diagnostic tests may be completed at the bedside or require transport outside of the unit.
The MSICU team may request the opinion of a specialist to optimize the treatment plan. This means that you may see other physicians coming to evaluate your loved one. They may have questions for you and may provide you with some information about their suggestions to the treating team.
Nighttime Coverage: At night, there is a resident physician on duty for the MSICU. In addition, there is an MSICU staff physician on-call. The staff physicians take turns being on-call, so it is possible that the physician on-call at night is not the same person who cared for your loved one during the day. The doctor on-call will be aware of your loved one’s condition and will be able to reach their usual doctor if needed.
Medical care is led by a team of Critical Care Medicine specialists (“Intensivists”) and patients are divided into 3 teams (Team A, Team B and Team C) to ensure a safe ratio of doctors to patients. There is one Intensivist per team, who changes once per week, on Friday afternoon. Team A is additionally staffed by medical students, residents and fellows.
Information and communication
Members of the MSICU team routinely meet with the patient and family to ensure that everyone has a common understanding of the health condition and the plan of care. You can expect that the MSICU staff will keep you informed of any major changes in the patient’s condition, procedures that are planned or being performed as well as goals for the day.
If you feel as though you are not receiving clear, easy to understand and complete information, a family meeting can be organized to facilitate communication between your family and the physician. During these meetings, it is a good time for the patient and family to ask any questions they may have. It can be helpful to write these questions down before going to the meeting to ensure that all your questions will be answered.
Take notes! We recommend that you take notes when speaking with the health care team. A lot of information may be presented during a family meeting, and it may be difficult to remember some of what is discussed. It may be helpful to think about what you would tell a family member or friend who wasn’t able to attend the meeting in person.
Equipment used to monitor and support the patient
Depending on the patient's condition, there may be many monitoring devices, intravenous lines, tubes and machines connected to them. The healthcare team can explain to you how each of these helps to support your loved one. You may hear many alarms. Most alarms do not signal an emergency – they alert the healthcare team to a problem or potential problem. The team uses this information, combined with their knowledge and experience, to guide therapy.
Sometimes families can be overwhelmed by all the devices, monitors and alarms. But remember that the purpose of your visit is to spend time with your loved one. Don’t let the devices distract you – hold their hand and speak to them. If you are worried about the equipment please feel free to ask a member of the healthcare team to explain to you what the equipment does and to reassure you that what you are doing is safe for the patient.
Control measures, commonly referred to as restraints, are sometimes necessary for the safety of patients. Patients can demonstrate periods of agitation or confusion due to their illness and the treatments they are receiving. Sometimes control measures are needed to ensure that a patient does not accidently remove or disconnect one of these necessary devices. All attempts are made to minimize the use of restraints and the use is regularly re-evaluated. If you have any concerns regarding these control measures, please speak to a team member.
Changes you may notice
The appearance of your loved one may change during their MSICU stay.
- Their arms, legs and face may be swollen.
- Their skin color may be different from usual.
- Bruising may occur.
- They often have one or more intravenous lines (IVs) in their arms, legs or neck.
Many critically ill patients develop a condition called delirium; they may become confused, agitated, paranoid, or hallucinate. This can be very distressing, both to the patient and their family. This occurs due to the illness, treatments and sleep deprivation, and it generally improves as the patient’s condition improves.
Patients in MSICU often require medication to keep them comfortable and safe, which may make them sleepy or ‘sedated’. The level of sedation will vary from person to person, depending on their condition. All attempts are made to minimize the use of sedatives and the use is regularly re-evaluated. The goal in most patients is to keep them as awake as possible as long as it is safe. It is important to remember that although patients may not be able to respond to a voice or touch, they may still be able to hear and feel. We encourage that you continue to talk to them, hold their hand and let them know of your presence.
We encourage you to speak with the team members should you have any questions or concerns.
Most of our patients require help with bathing, toileting, positioning and other forms of self-care. All members of our team have been trained to provide for the patient’s physical needs in a manner that respects their dignity and their privacy. If you feel that the patient would be uncomfortable with getting assistance from a nurse or attendant of a gender different, please inform the nurse and every possible effort will be made to accommodate the patient wishes.
Rehabilitation in the MSICU
The team strives to provide physical and cognitive rehabilitation to our patients whenever possible. The goal is to help promote the return to their functional baseline. Interventions can include sitting in a chair, standing, walking and participating in grooming and hygiene care.
Rehabilitation can be challenging for the patient, but the early initiation of patient participation in activities can maximize functional return and autonomy. In addition, these interventions can prevent or reduce the risks associated with immobility such as pain, delirium, pressure ulcers, depression and pneumonia.
How and when consent is needed?
Except in an emergency, no treatments can be provided to a patient without consent. While in the MSICU, your loved one may not be able to make choices with regards to treatments and care due to their medical status. The team will need your assistance in identifying a family member to represent your loved ones wishes. These wishes may have been mentioned in previous conversations or be documented in advanced directives. The healthcare team will use this information to help guide the treatment plan.
We will request a copy of any of the following documents to place in the chart.
Advanced medical directive or Living will
This document outlines the patient’s wishes for care and treatment, including treatments which patients may refuse. Patients may have already discussed their advanced directives with family, or have filled out the form on the Government of Quebec’s online registry for Advanced Directives. These documents may be accessed by the treating physician if a patient is not able to speak for themselves to help inform the treating team, and respect a patient’s wishes.
This is a legal document that identifies in advance one or several people to advocate on behalf of a person in the event of that they are incapable of consenting to care. Additionally, this document may contain patient’s preferences for care and treatments.
Power of attorney
This is a document giving someone the power to act on another person’s behalf for certain specific purposes. This measure is often used for paying bills/banking.
In the event that the above documents are not available, we follow the Quebec Civil Code in identifying the person who will best represent the patient. This can be the patient’s spouse, common law partner, children or any individual who shows special interest in the patient.
Additional information regarding the above can be obtained from the healthcare team.