Admission

This section explains the usual admission process and answers frequently asked questions regarding patient outcomes



- What is an Intensive Care Unit (ICU) / High Dependency Unit (HDU)?

The ICU is a ward dedicated to acute care of critical ill patients. Other than specialised, complex medical equipment, there is also a higher nursing and doctor to patient ratio.

At the moment, majority of the ICUs in Singapore are further specialized into Medical, Surgical, Neurological, Cardiothoracic, Pediatric, Burns and Coronary Care. Ng Teng Fong General Hospital and the future Seng Kang General Hospital are two hospitals with combined medical and surgical ICUs.

The HDU is also a ward dedicated to acute care of critically ill patients. HDU patients fall into two categories: patients who no longer need ICU care but not completely ready for the general ward, or patients who are too ill to be managed safely in the general ward but not yet requiring ICU care.

- Why is admission to an Intensive Care Unit (ICU) / High Dependency Unit (HDU) necessary?

Most patients in hospital receive and get better with general ward care. In a small proportion of patients, they require more support than possible in the general wards. These patients are considered for intensive care.

If your relative has:

  1. A potentially reversible medical condition
  2. Organ failure requiring intensive care support

He may be a candidate for intensive care.

Consideration is also given to his previous state of health and other medical conditions.

There are generally two broad reasons for ICU or HDU admission:

1. Precautionary - for closer monitoring in anticipation of potential medical complications. An example would be ICU/HDU admission after major surgery.

2. Resuscitation - when specialized, complex medical treatment and equipment are needed to keep the very ill patient alive.

- What does an admission to the Intensive Care Unit (ICU) mean to you?

For the family, the ICU environment both is intimidating and trying. The feeling of helplessness and uncertainty very common. You want to know what will happen next. You need to know what to expect.

You wonder about the chances of survival and whether there will be permanent disability. Your doctor and nurse are the best sources of information but it is not possible for the doctor or nurse to accurately predict outcome. There are also some indicators that you can use to help determine the severity of the patient's condition for yourself:

Less worrying:

  • Only one organ failing (being on a breathing machine, but the heart, kidneys and brain are functioning).
  • Not needing a breathing machine in two days or less.
  • Surviving a cardiac arrest and waking up within 1-3 days.
  • Blood pressure stable and not requiring medications.

Worrying:

  • Two or more organs failing.
  • Needing a breathing machine for more than three days.
  • Surviving a cardiac arrest but not waking up after 3 days.

For the patient, the ICU can be a hectic environment and many ICU procedures and treatment have the potential to cause distress and discomfort. Medications are often used to minimise pain and discomfort, but can result in sedation.

- What happens during admission?

Transfer to the ICU may be planned (elective) or unplanned (emergency).

In an emergency admission, a number of procedures are usually required at the onset. Treatment is started while the patient is closely monitored. Specialized investigations may need to take place before a diagnosis can be made. These interventions will take some time to perform.

- Who looks after the patient/who does what?

Medical Teams

In general, there are at least 2 teams looking after the patient, the ICU Team and the “Primary” Team.

The Primary Team, in most instances, is the General Ward Team or Service the patient was admitted to in the first instance. For example, general surgery, internal medicine or specialities such as respiratory/pulmonary or cardiology.

The ICU Team helps the Primary Team provide critical care for the patient during the ICU stay. The ICU Team is often divided into the Day Team and the Night or On-Call Team.

If the medical condition is complicated, the Primary and ICU Team may enlist the help of other specialist Teams such as Infectious Disease, Cardiology or Surgery.

Nursing

The nurses work on shifts and a senior nurse is assigned per shift to be the “In Charge” or “Charge Nurse”.

A staff nurse will be assigned to the patient and may be termed the “Room Nurse”. Depending on the ICU situation, the Room Nurse may be assigned to the care of up to 2 patients. If the patient’s condition is dire, there may be 2 nurses assigned to the care of a single patient. Assistant nurses may help with some aspects of the patient care.

Paramedical

This comprises a diverse group of healthcare workers ranging from Respiratory Therapists, Physiotherapist, Occupational Therapists, Speech Therapists, Dietician, Wound Nurses, Stoma Nurses, Radiology and Cardiology Technicians. Each hold a unique skill set to help in the complete care of the patient.