OK… makes sense to me now.
^^ this
ICU’s are for people who need more monitoring . Microsurgery on ANY limb or extremity is tricky and patients MUST be constantly watched to ensure there is no sudden drop off in circulation.
Well, for someone who has spent a lot of time in hospitals, I didn’t know there was a difference (or that some hospitals offer) between a medical ICU and a surgical ICU.
" I didn’t know there was a difference (or that some hospitals offer) between a medical ICU and a surgical ICU."
I might not know the difference between the different types of ICU’s but I certainly know the difference between a regular hospital room on a regular wing and an ICU. Unless I was unconscious or too sick to know where they heck I was.
Well my family member was not in an ICU and the reattachment didnt work. But that was after hospital # 1 didnt do a good job and hospital # 2 tried to fix it.
Depending on the hospital, there may not be. At large hospitals serving a big population base, they will have several speicalty ICUs. They might have a CCU (cardiac), Neuro, Surgical & Trauma (SICU), Med Surg (general ICU), Burns ICU, Open Heart & Thoracic surgery ICU, Pediatric ICU, Newborn ICU, and stepdown (at my hospital, stepdown was ICU-could be anyone critical or requiring intense monitoring not on a ventilator and had a 3:1 ratio vs normal 2:1).
At a smaller hospital, they might just have one adult ICU where anyone needing intensive care might be sent.
It’s devastating when that happens. I witnessed those kinds of outcomes in my unit and everyone is pretty upset when there is a failure. People take it personally and wonder if they missed something. The surgeon takes it the hardest.
And it was not an adult that lost it. Note above the second attempt was after the first was done after they were transferred from an adult to a pediatric facility. Was probably too late by that point.
The main thing which distinguishes an ICU from another unit is nurse to patient ratio. In an ICU, the nurse will typically not have more than one or two patients. Stepdown ICU at my hospital was 3:1. ICU patients are always on a cardiac monitor, many are on the ventilator.Though there are some floors which specialize in non critical patients on ventilators, most floors absolutely do not have the ability to care for patients on ventilators. Another thing which will buy a patient an ICU room as opposed to a regular room is if they are on a particular type of IV drip which has to be titrated frequently. Nurses with a lot of patients cannot be expected to manage these kinds of IV drips.
Finally, ICU nurses typically have specialized education or training. This is NOT to state that they are “better” nurses, smarter nurses, more caring, or anything of the kind. But the care involved requires different training.
My sister was in ICU for several days after some very complicated joint & vascular surgery. They have very little time to respond to vascularization problems and her arm required very, very frequent checks. I imagine the kind of hand surgery Fallon had could easily have required something similar.
(And it was definitely Bellevue where the surgery/recovery took place – Fallon explicitly mentions that he was transferred there because they had the specialized hand surgeon. I imagine that it takes a whole team of highly experienced folks to handle something like that, and I don’t have any reason to wonder why the team would be at Bellevue rather than some other hospital. Just as public colleges don’t equate to inferior education, public hospitals don’t mean inferior medical care.)
It was good of Fallon to thank Bellevue so publicly.
“The main thing which distinguishes an ICU from another unit is nurse to patient ratio. In an ICU, the nurse will typically not have more than one or two patients. Stepdown ICU at my hospital was 3:1”
Ok, thanks! And of course you’d have no idea how many other patients your nurse had.
I was thinking there was some obvious marker of a machine that went ping that meant ICU, and that everybody but me knew what that machine was!
@Pizzagirl, no you generally wouldn’t know how many patients your nurse has.
If the patient is hooked up to a whole lot of technology, that can also indicate ICU status, though that’s not written in stone. Heart monitor, all kinds of information visible on the monitor like arterial blood pressure, O2 saturation, etc. Multiple IV drips (as in 3 IV poles, each one with 3 or 4 things running at once), mechanical ventilation, of course. Machines connected to the patient which assist the heart, etc. are usually only used in ICUs or cardiac step downs. The more technology involved, the more likely it’s a case for ICU.
Or someone who has to be checked on for some reason every 15 minutes or so, if not more often.
Often ICUs will have somewhat limited access-you have to check in, or there are rules posted about how many people can be in a patient room at the same time, etc. Visiting hours will likely be less liberal than regular units, though of course all that is up for negotiation, depending on patient status and facility culture.
My wife was on a telemetry unit before working in an ICU. Typical telemetry patient loads for her was 12-15 patients, some sick enough to be in ICU but no beds available. She would see each one about once every 4 hours, not enough for this type of surgery.
In the ICU she would be assigned 1-3 patients, depending on how much care they needed. If needed, she could pull up a chair and sit, watching the patient. They routinely placed patients there who really didn’t need that level of monitoring , but it was small town hospital with limited revenue sources. Bellevue may not upcode quite as much.
That is completely crazy. Nurse to patient ratio in our telemetry unit was 1:5, and that could keep you hopping. Additionally, we had 24 hour monitor techs and 2 patient care aides. ICU was never greater than 1:2, stepdown was never greater than 1:3. Your wife’s unit was operating in an astoundingly unsafe manner and deviated abysmally from national standards.
California has legally mandated nurse to patient ratios. ICU is 1:2 or fewer, telemetry is 1:4 or fewer.
The 1:12-15 would not be legally allowed in any hospital unit in California. Maybe a long term care facility, but certainly not an acute care facility. It’s too bad all states don’t have similar mandates.
Burnout rate (and injury rate) was pretty high. Her shift was 7 pm to 7 am, no breaks, no time for meals. Days were a little better staffed. The nursing shortage was very real in the early 90s.
I knew an ICU nurse from NY who did Travelling Nurses, filling in during the LA nurse’s strike in the 1980s, caring for 6 to 8 ICU patients on 16 hour shifts. It would have been a bad time to get sick.
Whoa! I just saw this thread and haven’t read it all, and didn’t know about this injury. But, coincidentally, I was at a work reunion with some old friends last week, and one woman held up her hand to show us her missing finger, which none of us had noticed. Ring had caught on the edge of a boat when on a dive excursion, with her husband and kids. Finger degloved–eventually amputated.
Later in the evening, she showed us a picture someone had taken on the boat right after (don’t ask me why.) all I can say is, be glad I’m not describing it.
Actually degloving and just having the ring get caught is one reason that some people I know including H and a MD don’t wear rings. H used to pull cables at work and was not about to take the chance of having ring catch on it. I did catch my ring on a water slide but luckily was able to pull fingers, ring and hand free just in time. Didn’t go on any more water slides thereafter.
Fallon must be feeling better. he showed up at the U2 concert last night at the Garden and sang with Bono (my kids were there–I went Sunday so I missed this.)
Saw him on his show a night or so ago. Bandage is down to the one finger. Wish my family member had been so fortunate.
" How would I as a lay person who has spent zero time in hospitals except for my own birth and my children 's birth possibly know the difference? What would be the cues to look for? "
The actual sign that said “ICU”? Most units are marked.