Interactions with other departments

Although the ICU is usually self-contained and has its own complement of medical, nursing, and other staff, it certainly is not isolated. The normally busy ICU acts as a focal point of the hospital since from time to time every clinician will need to visit a patient, some very frequently. Doctors in training are often intimidated by equipment that they do not understand and terminology which is new to them, but this should not always be so. Training opportunities abound in intensive care, and all doctors in training would benefit from time spent learning the basics of resuscitation and recognition of serious illness.

During the course of a normal day the ICU has to cope with hundreds of individual visits by doctors, porters, cleaners, maintenance men, professionals allied to medicine, and of course patients' relatives. All too often supplies, beds, staff, visitors, and rubbish share a common entrance corridor cluttered by equipment spilling over from the store room. To cope with all this and retain a relatively calm non-threatening atmosphere for patients is perhaps one of the greatest challenges for designers and ICU staff.

Security is a major problem, and many units have installed entry-phone systems with the consequent need to provide a full-time receptionist to avoid repeated calls into the clinical area. Frequent telephone calls are unavoidable, but personal calls to staff on duty should be discouraged. The person answering the telephone has a responsibility to do so politely and professionally since no-one should be put off calling the ICU for help. Early communication about a patient may be lifesaving, and therefore good telephone etiquette is an important part of the well-run unit.

In the same way that early referral may be lifesaving, postdischarge problems and readmission to ICU may be avoided by provision of detailed information to the medical and nursing teams taking over the care of the patient. This is best done in writing in the case notes, but should be accompanied by a telephone call to inform the doctor or nurse in person. In that way good relationships are constructed. It is also good practice to send a formal discharge summary to the general practitioner who may be unaware that the patient has been seriously ill. This is particularly important because the details of a 2-month stay in the ICU may be glossed over by a busy doctor dictating the hospital discharge summary when the patient leaves the general ward. The pathologist will also appreciate information about the circumstances of a patient's death before performing a postmortem examination.

Good communication improves the image of the ICU and certainly makes it easier for ICU staff to enlist help when needed. The consultant radiologist is much more likely to take an interest in the investigation of an ICU patient if he or she is approached personally by an ICU doctor, and the surgeon performing a laparotomy on an ICU patient will feel more confident of the ICU team's involvement with the patient if they have demonstrated interest by watching the procedure and discussing the findings.

Intensive care medicine may be challenging, stimulating, rewarding, and depressing. Sometimes it may be all these things in one day. None of us can be expert in all aspects of medicine and surgery, but that is precisely the challenge of intensive care. Only regular contact between intensive care doctors and professionals of all specialties can provide the best care for our patients.

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