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. In normal times, 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 usually consists of two conjoined 22 bedded wards (4E and 4F). Each 22 bedded area is sub-divided into 4×4 bedded bays and 6 side rooms (of which 4 side rooms are interconnected). There are 4 single, negative pressure side rooms. During the peak of the pandemic, the unit expanded to cover several additional floors. We have so far looked after over 700 Covid-19 patients during the first 2 waves of the pandemic (reaching 157 on ICU at one point).
Operationally, 3 teams run the ACCU. Team A – beds 1 to 14; Team B – beds 31 to 44; Team C – beds 15 to 30. Each team has a consultant, a senior nurse, and a set of trainees allocated to it. The overall patient mix of teams A and B will comprise roughly 22 level 3 patients and 6 level 2 patients. 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).
There is a postoperative green unit on the 3rd floor that is also under our care. Roles and responsibilities related to this zone continue to evolve as we flex and contract throughout the pandemic.
One of the A – C consultants will take on the role of accepting consultant for the unit. This will either rotate or be taken on by the consultant with the lightest workload on a particular day. Overnight, a separate consultant is first on call (2nd on, for help, major incidents etc. rotates through A – C again); at the weekend the first on role rotates between the three consultants covering the unit. The details of this working pattern, which has changed during Covid, are likely to evolve further.
Trainees will be split between the three teams. Ideally, there should be a mix of seniority and base specialty across the floor. One of the job of the ACCU Registrar (‘D trainee’) is to help manage this allocation.
At night, although trainees are nominally split to cover the three Teams, you should all work together and help each other out when things are busy or if there is an emergency etc. We are all one Critical Care Team.
The first port of call from 20:00 until 08:00, for any query, is the ‘first on’ consultant.