General Information and Orientation

Welcome! The Royal London Hospital Adult Critical Care Unit is a 44-bedded mixed level 2/3 unit, with capacity for up to 22 level 3 and 22 level 2 patients. Level 3 Case-mix is varied, with approximately 30% surgical, 30% trauma and 40% medical patients. We admit ~1000 level 3 patients per year as well as ~2000 Level 2 patients – it’s busy!

The unit regularly uses ICP and other advanced neuro monitoring, proning and other advanced respiratory support, a variety of minimally invasive cardiac output monitors and we provide renal replacement therapy for ~10% of all admissions (twice the national average).

Geographically, the unit consists of two 22 bedded wards (4E and 4F). Each 22 bedded area is sub-divided into 4×4 bedded areas and 6 side rooms (of which 4 side rooms are interconnected). There are 4 single, negative pressure side rooms. The 2 areas are called wards 4E (generally level 3) and 4F (generally level 2).

Operationally, 3 teams run the ACCU, which are colour-coded. Team A (orange) beds 1 to 14. Team B (green) beds 31 to 44. Team C (blue) beds 15-30. Each team has a consultant and a senior nurse and a set of trainees. The overall patient mix of teams A&B will comprise up to a maximum of 22 level 3 beds and 6 level 2 beds. Though this can be flexed in special circumstances. Team C is Level 2 only (occasionally there have been Level 3 patients in this area though this is NOT routine and is a consultant / senior nurse only decision). At the weekends and overnight there are only two consultants covering, they take responsibility beds 1-22 and beds 23-44 each but the 3 nursing teams remain.

The two 7 man trainee rotas will always be based within team A and B but are expected to assist the Team C trainees in emergencies. The 16 man rota is split across Teams A, B and C.

At night there are 4 doctors from 22:00 until 08:00. Although it is nominally split so there are 3 covering Teams A&B and a 4th covering Team C you should all work together and help each other out when things are busy or if there is an emergency etc. In effect we are all one Critical Care Team.

The first port of call from 22:00 until 08:00, for any query, is the ‘first on’ consultant.