Critical care

You know your loved one best.

• Who are the people most important in the patient’s life?
• Who else would the patient want to know about their admission to critical care?

Travel safely to the hospital; consider having someone else drive you, if possible.

To get in, pick up the phone outside of the ICU/CICU/CSICU main doors. It will connect you to the unit clerk’s desk. Sometimes staff have stepped away from the desk, so let it ring a few times to give staff time to get back to the phone.

Our staff will open the doors and help you find your way to your loved one’s bedside.

Note: The main doors of the CSICU close after-hours and on weekends. During business hours (6:30 a.m. to 4 p.m.), the doors are open and you can walk to the CSICU doors. The unit closes its doors after 4 p.m. on weekdays, and all day on weekends and holidays. You will need to call the CSICU from the main hall doors to have them opened. You will then need to walk to the CSICU’s main doors and call again from the CSICU doors.

Your loved one’s condition will determine where you will find them in the critical care complex. If you are ever unsure of which critical care unit your loved one is in, please call the Intensive Care Unit: 604-682-2344, ext 62264.

• Intensive Care Unit (ICU): Patients in the ICU are experiencing unexpected life-threatening illness (e.g., sepsis, pneumonia, multi-organ dysfunction).
  • The ICU at St. Paul’s Hospital is on the 3rd floor of Providence Building, around the corner from the Providence Building elevators.
  • When you come off the elevators on the third floor, turn right and follow the signs.
  • Telephone: 604-682-2344, ext 62264
• Cardiac ICU (CICU): If your loved one’s main concern is related to a cardiac event (e.g., a heart attack or myocardial infarction), they will be in the CICU.
  • The CICU at St. Paul’s Hospital is on the 3rd floor of Providence Building, around the corner from the Providence Building elevators.
  • When you come off the elevators on the third floor, turn right and follow the signs.
  • Telephone: 604-682-2344, ext 62285
• Cardiac Surgery ICU (CSICU): If your loved one has undergone a planned or unplanned cardiac surgery (e.g., heart surgery, heart transplant, etc.) they will be receiving their care in the CSICU.
  • The CSICU at St. Paul’s Hospital is on the 3rd floor of Providence Building, around the corner from the Providence Building elevators.
  • When you come off the elevators on the third floor, turn left and follow the signs.
  • Telephone: 604-682-2344, ext 62117

If your loved one is admitted to the critical care complex, the care team will try to get you in to see them as soon as possible. This may take up to an hour, and sometimes longer, after your arrival to the critical care complex. The team’s focus is on stabilizing your loved one. If you have been waiting more than an hour, please check-in at the nursing station again and see if you can get an update.

The doctor will have a family meeting to share information with you as soon as they can. If you have been waiting more than an hour, it is okay to ask for an update.

The care team will ask you to stay nearby or give us a telephone number so we can reach you to share information.

Please note: For planned admissions to the CICU and CSICU, family meetings are still important to the provision of care. These meetings simply won't be as often because of the expected nature of your loved one’s stay with us. If you want a family update, you can ask for one at any time.

Please help us prevent the spread of infection. It is very important that you wash your hands well and often. As a valuable team member, feel free to remind us to wash our hands before and after caring for your loved one.

Wash hands or disinfect with hand sanitizer:

• When you enter the ICU
• Before and after giving any care to your loved one
• Before you eat food
• When you leave the patient’s room

We are a smoke-free facility. There is no smoking allowed inside or around the building.

Many people are sensitive or allergic to fragrances and perfumes. We work hard to ensure that our hospital is scent/ fragrance-free. Please help us keep everyone safe by avoiding things like:

• Using perfumes or colognes.
• Flowers or plants.
• Other scented products, such as fragrant soaps, lotions or ornaments.

We try to keep the patient’s information private. You may overhear the team talking about other patients. Please help us protect privacy by not sharing information you may overhear.

Please take your loved one’s clothing and belongings home for safe keeping. The hospital is a public building with many people coming and going. Do not leave any personal belongings in the family lounge unattended; it is not a secured area.

Some infections are easily spread. Critically ill patients have a greater chance of getting an infection. For this reason, you may see health care professionals putting on gowns, gloves and/or masks before caring for your loved one. These precautions protect them and others from infection. If needed, the nurse can show you how to put on and remove gloves, gowns and/or masks. Ask your loved one’s nurse if you have any questions.

Read more on Infection Prevention and Control practices.

• Has your loved one spent time in the hospital before? How did they feel about it?
• Has your loved one known someone who has been in a similar situation? What were their thoughts about it?
• Has your loved one talked about their wishes, values, or fears? Have they spoken about how these may affect their healthcare decisions?
• What are your loved one’s values, wishes or beliefs? Comments made by your loved one in the past can help us understand what is most important to the patient.
• What abilities are important to them?

When a patient cannot make medical decisions for themselves, one person needs to be the Substitute Decision Maker (SDM).

If the patient is unable to, the SDM is assigned to make medical decisions for them. The contact person often also acts as the SDM, but this does not always have to be the case. It depends on what works best for your family. Other members of the family can still be involved in the decision making.

The goal is to ensure medical decisions match what the patient would have wanted if they could speak for themselves.

There are a few ways to select the SDM:

• Temporary substitute decision maker (TSDM): If the patient hasn’t formally appointed an SDM for medical decisions (i.e., Representation Agreement) we can appoint a TSDM. A TSDM must be a family member or friend with a close, meaningful relationship with the patient. They must be able and willing to take on the role.
• Representation Agreement: This is a document wherein an individual identifies who they want to make medical decisions for them if they cannot. If your loved one has a Representation Agreement, please bring in a copy. The critical care team needs to review it.

Decision making when a loved one is in critical care is an important but often challenging role. We are here to help. Please talk with a unit nurse or ask to speak with a social worker. They can give you more info or help with decision making.

When patients are on life support, are unconscious or confused, they may be unable to communicate with their care team. Families can play an important role. They can help the care team get to know your loved one until they can speak for themselves.

Not only is medical and health history important, but so is your loved one’s spiritual health practices and beliefs, personal preferences and who they are as a person.

Whether a loved one's stay in critical care was planned or unplanned, if you want to connect with Pastoral Services and Spiritual Care and /or the Indigenous Wellness Liaisons team, let us know. We will be happy to help make that connection.

There are shared family lounges available for the ICU, CSICU and CICU. You are welcome to use this area any time. Keep in mind these areas are shared with other families who are also going through a difficult time. Be aware of noise levels and try to keep what you may overhear confidential. The lounge may be locked at night; please speak with the unit clerk or nurse to unlock it.

We try to maintain a safe environment for all patients, families and staff. We may limit the number of people at the bedside. This is to make sure the critical care team has enough space to care. Please speak to the bedside nurse if you have any concerns.

Some activities that typically occur during the day are:

• Shift Changes take place twice/day. Following the handover of patient care, nurses spend up to an hour doing an in-depth assessment and organizing care.
  • In the morning: 7:00 – 8:00 a.m.
  • In the evening: 7:00 – 8:00 p.m.
• Daily rounds occur anytime between 8:30 a.m. – 12:30 p.m. They take approximately 15 to 30 minutes for each patient. The team comes together to review the patient’s status, plans and goals of care for the day.
• Early Mobilization: The care team will support patients to move as soon as they can. This is true even when they may still need oxygen or the breathing machine. Moving patients to sit, stand or even walk as early as possible can help patients survive and recover. View the mobilization stages.

What is delirium in critical care?

Your loved one may appear confused, forgetful, excited, or even angry. Sometimes your loved one may not recognize you. You may hear the term ‘delirium’ used to describe your loved one’s mental status. Delirium is usually a temporary state where a patient is confused or unable to think clearly. It is not uncommon for a patient in critical care to have delirium at some point during their stay. Delirium may come and go quickly or last days to weeks.

They may see or hear things that are not there or may be withdrawn and/or agitated. It can be helpful to write down what your loved one has experienced in intensive care. Once they recover from delirium, their memories of their time in the critical care complex may be jumbled. Being able to read about what you saw them go through can help them make sense of their time.

While it can be scary to see your loved one experience delirium there are many things we can do to help. Critical care nurses screen for delirium every day, but you know your loved one best. Let the nurse know if you notice changes in the patient’s mood or behaviour. Please bring in the patient’s glasses and/or hearing aids, if they have them. Being able to see and hear clearly can help patients make sense of their surroundings.

When you have a loved one in intensive care, you may struggle to talk with them. This can feel scary or frustrating. Things that can contribute to this are as follows:

• Oxygen therapy or mechanical ventilation – will make it difficult or impossible to speak
• Fatigue
• Delirium
• Vision/hearing impairments

We are here to support you through barriers to communicate. There are things that you can do to improve your ability to communicate with and connect to your loved one:

• Bring in and label hearing aids and glasses (this is very important)
• Ask “Yes/no/I don’t know” questions
• Some helpful resources can be found here and here that you may be able to use when communicating with your loved one. Your health care provider regularly uses these tools, and you are more than welcome to use them as well.
• Ask your nurse or medical staff for the support of a speech-language pathologist (SLP).

It is important to be mindful that death is a possible outcome of any critical care stay, just as recovering and being released in good health is.

Know that we are here to support you during this time, whatever the outcome. Social workers can connect you to a host of grief support services. Wishing Well is a project to humanize and dignify illness in the critical care units at St. Paul’s Hospital. It is one such initiative to offer bereavement support. Patients and families are invited to share wishes as a way to bring the focus on the patient, rather than their critical illness. Read more about Wishing Well.

Please refer to Advance Care Planning for additional information.

If you would like to be connected to Pastoral Services and Spiritual Care and / or the Indigenous Wellness Liaisons team, please let us know and we will be happy to facilitate that connection.

Many doctors with specialized training may be involved in the care of your loved one.

• In the ICU, the Attending Physician is an Intensivist. They specialize in caring for critical care patients.
• In the CICU, the Attending is a Cardiologist. They specialize in caring for patients with heart problems.
• In the CSICU, the Attending is a Cardiac Surgeon Anesthesiologist. They specialize in caring for patients needing heart surgery, as well as during and after surgery.
• The Fellow is a doctor who has nearly completed their specialty training.
• Residents are doctors who are beginning training in specialty areas such as ICU, cardiology or cardiac surgery. They work under the supervision of the Fellow and/or Attending Physician.

Critical Care Nurses have special training. They care for patients with a critical illness. The Bedside Nurse is the one who will give direct care to your loved one. ICU/CICU/CSICU nurses usually look after one patient. This allows them to closely watch the patient and respond quickly to any changes if they need to. The Clinical Nurse Leader (CNL) or Charge Nurse keeps the whole unit running smoothly.

The unit clerk may be one of the first people you speak to. They answer the phone and help you find your way to your loved one in the Critical Care Complex. They will also help you connect with the right nurse when you are calling from home.

The Social Worker can provide practical and emotional support to help families cope. They can help with things like:

• Links to community resources
• Financial and/or legal matters
• Tools to help you find a place to stay or get around
• Ensuring patients’ and family’s cultural and language needs are met
• Share the patients' wishes, and support with decisions

Let your nurse know if you would like to talk to a Social Worker.

Respiratory Therapists are healthcare professionals with expertise in the respiratory system (lungs). They manage many treatments that help a patient breathe. This may include oxygen therapy, the breathing machine (i.e., ventilator) and some medications.

Physiotherapists help patients and the ICU team to safely move patients even when they are critically ill. It is important that your loved one move around early in their ICU stay. Simple things like sitting up, standing, and walking help patients save their muscles. They also help them breathe without a machine and regain strength after a serious illness.

The Spiritual Health Practitioner is there for patients, families and their friends. They can help with grief, loss and other difficult emotions. They also offer spiritual support and multi-faith services. They respect all religions and beliefs including not believing in (i.e. atheist) or knowing of a god (i.e. agnostic). They can help with arranging prayer, ritual and sacrament. They can help to have your own community spiritual leader to visit.

Many health professionals care for your loved one. You may not always see them all the time. Here are some of the other people who work in the critical care complex:

• The Dietitian will make sure your loved one gets the right amount of nutrients for energy to heal. This will help them recover from their critical illness.
• Indigenous Wellness Liaisons work with the critical care team to provide culturally safe care to patients, families and the community. They can provide many services. These include ceremony, blanketing, drums, and songs. They also include access to traditional medicines and other supportive care measures. Please talk to your nurse if you are interested in these services. Find out more about the services and supports offered by the Indigenous Wellness Liaisons.
• The Patient Care Manager handles running the individual units that make up the critical care complex.
• The Pharmacist helps ensure your loved one’s medications are the right drugs for the patient. They review the patient’s medication list daily with the care team.
• The Research Coordinator works with other members of the critical care team. They co-ordinate many research projects. They might talk to you about your family member participating in research. Your decision to take part in a study will not affect the care your loved one receives, and it is voluntary. Learn more about Providence Research here.
• The Speech Language Pathologist (SLP) helps patients who have new speech, language, swallowing, and/or communication problems.

The ICU at St. Paul’s Hospital is a 19-bed unit – we care for 800 to 1000 patients a year.

ICU team members work closely with families and patients. We provide psychological, spiritual, and emotional support. Nurses provide one-on-one care for patients.

Our ICU is staffed with an award-winning team. We won a 3M Award for our work in sepsis, a life-threatening infection.

Our clinicians are recognized as world-leaders in both patient care and research. Areas of clinical focus are in:

• Sepsis management
• Acute respiratory failure
• Renal failure
• Multi-system organ failure

Our interdisciplinary care team may include physicians, respiratory therapists, pharmacists, nutritionists, pastoral care workers, physiotherapists, social workers and music therapists.

St. Paul’s Hospital performs over 1,100 heart surgery procedures every year.

The CSICU is a busy 11-bed unit, home to a world-class multidisciplinary team. The team includes Cardiac Surgery, Cardiology, Anesthesia, Perfusion, Nursing, Physiotherapy, Pharmacology, Respiratory Therapy and many other supporting professions.

St. Paul’s Hospital is considered the Centre of Excellence for Cardiac Sciences in British Columbia. We are the referral centre for BC. We help the most complex patients who need advanced mechanical assist devices and heart surgery.

This work is lead by The Heart Centre, which specializes in:

• Open heart surgery
• Heart transplants
• Coronary artery bypass
• Valve repair/replacement surgery
• Acute heart failure
• Insertion of mechanical heart assist devices

Below are resources that you might find useful. Please ask your care team if they have more resources to share with you.

• Living with a Heart Transplant
• Heart Transplant Zones
• Coping with Heart Transplant
• Cardiac Surgery Patient Guide
• Critical Care Handbook for Patients and Families

The CICU is an 11-bed unit that stabilizes all critical heart-related illnesses for patients from around the province.

We offer all services from heart disease prevention to heart transplantation. A few examples include: mechanical hearts, pacemakers, internal defibrillation devices and Transcatheter Aortic Valve Implantation (TAVI). The multidisciplinary CICU team liaises with the Cardiac Interventional Units and Cardiac Surgery Unit to expedite life-saving procedures.

Below are resources you might find useful. Please ask your care team if they have more resources to share with you.

• ECMO Family Guide
• You are having a Transcatheter Aortic Valve Implantation: Alternative Access Approach
• Surviving a Cardiac Arrest – Information for Patients and Families
• Critical Care Handbook for Patients and Families