Organ Support in Areas Outside the ACCU

Renal HDU

A 6-bed unit on the 9th floor, which can provide one additional organ support (in addition to dialysis) i.e. low dose vasopressors (Noradrenaline <0.2 mcg/kg/min), CPAP. They do not provide CVVH(D)F or BiPAP.

Neuro-monitored bay

An 8-bed unit on 12E, which can provide tracheostomy care and CPAP.

NIV Unit

The respiratory ward (13E) has up to 4 BiPAP beds but the number can vary.  As the Barts Respiratory Ward does not take acute admissions, ACCU will take emergency (i.e. ED) admissions as per the normal referral route.

Many wards can take patients with tracheostomies (but patients in side room or those with single lumen tracheostomy tubes) will require a ‘special’.

Obstetric HDU

A 4-bed unit, which also serves as obstetric theatre recovery has recently opened on level 6, on the link between the South and Central towers (directly over the canteen).  No organ support is provided here, simply closer monitoring of sick obstetric patients.  You may be asked to review a patient here.

Recovery

Occasionally elective surgical patients who are due to come to HDU and have been given a bed have to wait in recovery for a space to be cleared in our HDU.  These patients, once they have been recovered from their anaesthesia, become ACCU / HDU (i.e. OUR) patients!  A kind anaesthetist may help you out, but they need to be seen and clerked by us and placed on the whiteboard in the 4F doctors office.  Usually the wait is brief but, previous trainees have found it very useful to go to recovery and start clerking them in, sorting out the drug chart etc. in anticipation of their imminent arrival.  Please leave the HDU documentation with the patient in recovery, otherwise the nurse looking after them won’t know what your plan is.

If an elective patient requiring level 2 care is operated on in the knowledge that there is no HDU bed and then ends up in recovery, this is the responsibility of the anaesthetic team, NOT you!  If you are called to see them, please call the HDU consultant (45713) or the first on consultant (45711) out of normal working hours.

In general it is best to work in concert with the theatre anaesthetists to ensure safe management of patients in recovery.

Wards

General wards are not suitable locations for patients requiring organ support to be cared for.  You must stay with such a patient until they can be transferred to a safer location.  This should be the ACCU, but if there is likely to be a prolonged delay consider moving the patient to recovery or an anaesthetic room, after discussing this with the on-call consultant.