The Medical Intensive Care Unit, or what people commonly call the ICU, can be just that – intense.
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The focus of the ICU is to stabilize, diagnose and allow a patient to recover. Many patients in the ICU have other diseases in addition to the severe illness that made them so sick, says critical care physician Eduardo Mireles-Cabodevila, MD. These patients require round-the-clock care and multiple teams to care for them.
In these situations, feeling can run high for both patients and families. Here are three questions to ask doctors and caregivers to stay informed.
1. How and how often can I get updates about my loved one’s condition?
Asking this question will help you set expectations. As a general rule, the ICU team will contact you when things change drastically or when they need to inform you on events, Dr. Mireles-Cabodevila says – for example, if your loved one needs a procedure.
Most ICUs also have a time of the day when the patient and family are informed on the patient’s progress. Many intensive care units allow and/or encourage the family to be present during the team rounds. Although medical language can sound foreign or complicated, don’t be shy to ask the team to explain.
Some ICUs allow you to request phone calls by the bedside nurse at the beginning and end of his or her shift, to keep you updated of any needs. This is helpful when you are unable to be at the bedside and just want to be sure that things are OK.
Remember, you can always ask to speak to the attending physician by asking the nurse or one of the other team members. The afternoon hours are the best time of the day for physicians to speak with you.
2. Who is part of my loved one’s medical team?
This is a very important question. The ICU team is truly a team. You want to know who is directing the care team, and which team members are able to provide a complete statement of the plan of care.
You can expect close to 10 professions to be involved in helping your loved one recover. This means that you will see a lot of people come into the room, all of whom have specific roles and responsibilities.
Many times, a consultant may also come into the room to discuss parts of the care. This is a common source of confusion for families, Dr. Mireles-Cabodevila says, as they hear many opinions. When this happens, ask to talk to your team.
It is also important to know that the number of physicians available at night is less than during the day. Although the physician at night is capable of caring for your loved one, it is best to leave deep conversations to the day team.
The ICU team is made up of the following:
- Attending (staff) physician —This doctor specializes in pulmonary or critical care medicine and oversees all of your loved one’s care.
- Fellow —This doctor has graduated from medical school and is now receiving additional training in pulmonary medicine and/or critical care. He or she will likely help the attending physician with procedures and care management.
- Resident — This caregiver is a licensed medical doctor who is continuing training in internal medicine. He or she works closely with the attending physician and fellow.
- Intern — In this case, an intern is still a licensed medical doctor, but he or she is in the first year of training after medical school. An intern may be involved in performing some tests and daily exams.
- Consultant — A physician who specializes in an area of medicine or surgery. The consultant provides focused recommendations on specific problems.
- Advanced practice provider (APP) – A healthcare professional, nurse practitioner or physician assistant who participates in all aspects of care and collaborates with physicians to implement a plan of care.
- Registered nurse (RN) – An RN provides you and your loved ones with information about medicines, tests and procedures. The RN will be the most available to you since he or she is assigned to no more than one other patient in the ICU, and it is typically the patient in the next room. The same number of nurses are available at night as during the day.
- Respiratory therapist (RT) — The RT monitors a patient’s breathing and cares for those on mechanical ventilators (e.g. breathing machines). The RTs care for several patients (6 to 10) at the same time.
- Pharmacist — A pharmacist is available every day for the physicians and nurses to monitor the drugs your loved one is receiving and to answer questions from them.
- Case manager/social worker — Case managers and social workers are available to provide individual and family counseling as well as information on financial assistance, support groups, lodging, employment and disability information, among other needs.
As you can imagine, multiple shift changes occur, so familiarize yourself and your family with each member of the medical team.
3. What sort of recovery should I expect?
Recovery time in the ICU can be highly variable, from a few days to a few weeks. At times, it is too early to know how long recovery will take, but asking can help you plan your time and resources.
Stay in touch with the attending physician in a continued, open relationship. This doctor and the medical team can advise you on the condition of your loved one’s health and next steps.
4. How can I help with recovery?
There are times when you may have to let the team do a procedure or let your loved one rest. But the rest of the time you can be doing things to help – for example, bringing pictures of them and their loved ones, or telling the care team what they like to eat, what TV programs they like to watch or what music they like to hear.
You can help your loved one stay engaged by telling family stories, reading to them, playing games or updating them on world news. Just be sure to ask the care team if there are any restrictions on interactions you can have with them. (Is it OK to give him a foot massage? Can I comb his hair? Move his arms?)
Long gone are the times where patients where kept isolated from their families. “We have learned a lot over the last decades,” Dr. Mireles-Cabodevila says. “Family at bedside is welcomed and essential.”