Just the name ‘intensive care’ sounds scary,
conjuring up images of a brutal medical front line where doctors and nurses
engage in a technological battle to keep patients alive.
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But now a team of NHS medics has come together to humanize
the units, recognizing that people heal best when their minds are attended to,
as well as their bodies.
On the fifth floor of
Chelsea and Westminster Hospital, in
West London, they have created a new type of intensive care which they hope
will serve as a model elsewhere, and The Mail on Sunday was granted an
exclusive look.
Alongside the usual array of vital machines needed to
maintain life as it teeters on the edge, they have introduced a range of
equipment, activities and techniques aimed at restoring the patient as a whole.
Dr Alice Sisson, director of the hospital’s adult intensive
care unit (ICU), explained: “ICU is about saving the sickest people in
hospital. Surviving it, and surviving a critical illness, is a real
achievement. But to get better you need all your senses nurtured.”
Amid growing evidence of the crucial importance of a good
night’s sleep in promoting recovery, they have prioritized making the unit as
quiet and sleep-friendly as possible. Instead of the noisy clatter that is so
typical of hospitals — the banging doors, the swishing curtains and constant
beeps — is a soothing calm.
“In a normal ICU the noise level is about 80 decibels,” said
Dr Sisson — about as loud as a passing truck. “Here, it’s around 50,” more like
that of falling rain.
Bins have soft-closing lids, while “a deliberate decision”
was taken to eschew automatic doors for manual ones.
“Once someone has walked past an automatic door, it will go through
its whole open-close cycle,” said Dr Sisson. As anyone who has ever been seated
near the carriage door on a modern train knows, such intermittent noise can be
torture. Imagine enduring that for weeks, or even months.
It is a small detail but indicative of the immense thought
that has gone into planning the 22-room ICU refit, paid for in part with a
£12.5 million fundraising drive that was organized by the hospital’s charity,
CW+.
The rooms themselves — 40 per cent bigger than before — have
been set up to “normalize” as much as possible being in ICU, which can be a
deeply disorientating experience.
That matters, said ICU consultant Marcela Vizcaychipi,
because the more disorientated that patients are, the more likely they are to
suffer delirium.
Frequently delirious patients have worse outcomes and are
more likely to die. So most medical equipment in the new rooms is placed out of
sight, behind the bed, while the familiar objects of a television and clock are
placed in front.
And rather than the beds facing inwards, as they were
before, they are positioned so that patients get a sweeping view over
north-west London — giving them something to focus on.
The abundant light helps reset patients’ natural sleep-wake
pattern (called circadian rhythm), which can be obliterated after lengthy
sedation but is vital for good, restorative sleep.
This also helps reduce delirium, said Dr Vizcaychipi.
Electrical lights can be varied to mimic the time of day —
softer in the evening, for instance — a far cry from the merciless fluorescent
strips so common on most wards.
Besides offering TV channels, the screens can be set to show
relaxing nature scenes, photos and videos sent in by loved ones, or used for
video calls.
Activities have been introduced to help the more alert patients
keep interested in life, notably simple craft packs such as paint-by-numbers,
and even live musical recitals.
Lead nurse Elaine Manderson said: “For some patients, their
illness becomes chronic.
“They can struggle to see a way out — it can seem never-ending.
So even doing something small can be therapeutic.”
During the pandemic, resident pianist Andy Hall, who is paid
by CW+, performed request shows via Zoom from his Croydon home, and now does
them in person.
“Patients are sometimes astonished when they find a pianist
by their bedside,” said Mr Hall, who is also researching the effect of music on
physiology.
What is the best music to aid a patient’s recovery? “It’s
impossible to draw universal conclusions,” he said. “The best music is the
patient’s favorite music. For one person it could be Stormzy – Cliff Richard
for the next.” But he said simply enabling patients to choose what he played
helped: “It’s about giving them back a sense of control.”
Visitors’ sofa
Better than chairs, as a sofa enables family or friends to
sleep. Positioned out of the way of medical staff, it has power points and USB
mobile phone charging ports fitted for convenience.
Large windows
Let in abundant natural light to help the body clock.
Equipped with blackout blinds to aid sleep if needed.
Lights
Can be dimmed and color-adjusted to mimic different times of
day. Special purple lights help calm patients who are delirious.
Bed
Placed parallel to the window, giving the patient a view of
the outside world. Most monitoring equipment is positioned behind the patient
to make the room feel less clinical. A television is attached to the wall in
front of the patient, much like in a modern hotel.
Air supply
Changed ten to 12 times an hour, the highly filtered air is
constantly monitored.
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