Intensive Care

  • The Intensive Care Unit (ICU) and High Dependency Unit (HDU) are for patients receiving intensive monitoring and specialised nursing and medical care during the most critical time of their illness. They are also known as the Critical Care Unit.

  • Address: Maidstone Hospital and Tunbridge Wells Hospital,

What we do

Critical care includes intensive care units (ICU) and high dependency units (HDU) and is where advanced medical treatment is provided and critically unwell patients are monitored.

Patients in ICU need the most support, such as life support for multiple organs. 

HDU provides a level of care that's a 'step-down' from ICU, or for those recovering major surgery who need more monitoring than a regular ward can offer. 

Patients may be admitted to critical care if they have had planned or emergency major surgery, have serious short-term conditions such as a stroke, or a serious infection like sepsis or severe pneumonia.

Our critical care units have 24-hour cover by professionals specially trained in critical care medicine. Consultants are supported by a multidisciplinary team, who work together to care for our patients, including doctors, nurses and therapists.

Critical care at Tunbridge Wells Hospital includes the Intensive Care Unit and High Dependency Unit. The ICU has 9 beds and the HDU has 8 beds. All are single rooms. 

The two intensive care units work closely together to provide the best care. Patients may be transferred between the two units if they need specialist services.

Our team

Administrative team

Our administrative teams ensure the smooth running of the department by making sure all documentation and data is kept up to date. 

The first staff member you are likely to meet as a visitor is the ward clerk. They will liaise with the team looking after the patient to make sure it is an appropriate time to visit.

They may ask you to wait if the patient is receiving treatment or bedside care. This is to ensure patient safety, dignity and privacy. 

Doctors

We have a team of consultants (known as intensivists - specialists in intensive care medicine) who lead on ICU and review the patients twice a day.

Doctors make daily plans for patient care and lead on providing organ support, initiating treatments and requesting any further investigations that may be needed. These are often made during a ward round and include the senior nurse and other members of the multidisciplinary team.

The doctors consider the changing condition of the patient and adjust these plans as needed. 

To ensure all our patients receive the highest level of care, they seeks advice from other specialties such as cardiology, urology and neurology, and the surgical teams.

Nurses

Our specialist nurses will be allocated one or two patients to care for during their shift, depending on the level of care each patient needs.

They set up, deliver and adjust organ support; give medication, and carry out personal care such as washing, as well as liaising with families.

They are led by a team of senior nurses and matrons, who help ensure the smooth running of ICU.

Clinical support workers

CSWs assist with personal care, pressure area care, mobilisation (movement) and interpersonal communication.

Dietitians

The ICU dietitians provide advice on the best way to understand and deliver patients’ nutritional needs.

They help decide how to provide nutrition and how much energy - or calories - and protein the patient needs to help reduce the loss of muscle and weight.

The dietitians contributes to consultant-led ward rounds and multidisciplinary team meetings. They have regular meetings with consultants to share nutritional goals, risks and plans.

Physiotherapists

Physiotherapists are a fundamental part of the team, and their specialist skills and early involvement are very important for patient recovery.

They work closely with occupational therapists and the rest of the team to build and maintain patients’ physical strength and function after prolonged ventilation, illness, surgery and/or bedrest.

Physiotherapists also help with respiratory management and early rehabilitation for patients. 

They work closely with occupational therapists and the rest of the team to restore and maintain patients’ physical strength and function after prolonged ventilation, illness, surgery and/or bed rest.

Early rehabilitation has been shown to be safe and effective, and may include:

  • stretching and mobilising the limbs to maintain range of movement
  • early mobilisation, where a patient's readiness to move is assessed as early as the day after surgery or while they are still on a ventilator
  • transfer practice to get the patient out of bed as soon as possible
  • patient-centred exercise programmes, including cardiovascular fitness, strength training and balance exercise
  • helping with personal care and restoring the activities of daily living
  • rehabilitation, alongside respiratory management, aims to improve patients’ physical abilities and work towards regaining their independence

Occupational therapists

Occupational therapists help with rehabilitation by helping with the functional, cognitive and psycho-social needs of our patients.

Speech and language therapists (SaLT)

SALTs help to ensure patients recover the ability to speak and eat safely and smoothly. 

After spending time in ICU, patients’ voices and their ability to swallow are often affected, particularly if they have spent time on a breathing machine and/or have been fed through a tube in their nose.

Pharmacists

Our pharmacists ensure all medication prescriptions and deliveries are safe and reliable.

They also help to ensure there is enough stock of all the medications needed for the day-to-day running of the unit.

Clinical psychologists

Our psychologists are here to help support the needs of patients and families. They know ICU can be a very stressful place. It is common for patients to feel anxious, down or confused. Families may also find it a very worrying time.

The Psychology team can help patients and families cope with difficult experiences such as delirium, uncertainty, end-of-life or bereavement.

Psychological support can help people get more benefit from their clinical care and rehabilitation. If we find patients are still suffering from psychological difficulties when they leave ICU, we may suggest other services to help them in the longer term.

If you have not met one of our psychologists while in ICU, but think this may be helpful, please let the bedside nurse know.

Get in touch

Maidstone Hospital

Intensive Care (ICU), blue zone, first floor

  • Unit A: 01622 222025 or 01622 222028
  • Unit B: 01622 224398 or 01622 224401

Matron: Sarah Driscoll

Tunbridge Wells Hospital

Intensive Care (ICU), Level -1, purple zone

Tel: 01892 635446

High Dependency (HDU), Level 1, purple zone

Tel: 01892 638531

Matron: Alejandro Suarez

Tel: 01892635757

Email: alejandro.suarez@nhs.net 

Visiting

Our visiting hours are 11am to 7pm.

Because of limited space and the need to allow staff to work around you, we ask only two people to visit at a time.

However, there may be times when this changes. This decision will be made by senior medical and nursing staff, to prioritise patient care and safety and to support the wellbeing of our visitors. 

It is a good idea to call the nurse to check visiting hours and bedside capacity before you arrive.

Visiting a patient in hospital

Infection prevention

When you visit an ICU patient please make sure you are in good health, to avoid the risk of spreading infection to our critically ill and vulnerable patients.

We ask you not to bring flowers as these are not allowed in ICU, to help prevent infection.

Preparing to visit

An intensive care unit can be an overwhelming place for patients and their families. You can find more information on what to expect when when visiting an ICU on the NHS website.

It is important to know what to expect during your visit. Your relative/friend may be attached to several drips, drains and pieces of specialist equipment.

This is quite normal in the ICU but may be a shock, so please feel free to discuss your feelings and ask us any questions.

The daily routines in ICU are different from other wards because it is a specialist and complex department. There is a high level of activity all day and night and noise levels are likely to be greater because of the operation of equipment, often beeping or sounding an alarm.

An alarm doesn't necessarily mean something is wrong, just that there is something that staff need to be aware of. We will be able to explain the equipment and noises to you.

Information sharing

While your relative is in ICU it is helpful to identify a next of kin as a point of contact, who can be given updates about the patient.

They can then update family and friends as they wish.

All patients have a right to confidentiality, and we have an ethical and legal obligation to ensure confidentiality of patient information.

This means in some circumstances we won't be able to give out detailed information. 

Patients and visitors often create a password that can be given by a family member to staff, confirming they are allowed to be given clinical updates and/or visit. This makes sure information is being shared with the correct people.

Please let the bedside nurse know if you would like to use a password and what the password is.

They will record this in the patient’s notes and hand it over at every shift.

A typical day in intensive care

All patients are seen on admission and then at least twice per day by the Intensive Care Consultant. This is an experienced senior doctor who has had specialist training in caring for the critically ill. 

Patients also remain under the care of the specialist consultant who admitted them, and there is a resident doctor (experienced in care of critically ill patients) on duty on the units at all times. 

A ward round takes place every morning where the plan for the day is decided. Visitors are usually asked to leave during the ward round to ensure privacy for all patients on the unit. Visitors will be kept up to date with the plan and progress of their relative.

All patients are seen at least daily by the physiotherapists, dietitians and other specialists as necessary.

ICU patients often need regular chest x-rays, CT scans and other diagnostic tests. They also need a high level of nursing care and medical interventions. Visitors may be asked to leave and wait in the waiting room while we carry these out.

More information is available in our patient information library

How intensive care affects the patient

No two experiences of ICU are the same but for many patients this is a very stressful time.

ICU patients often become swollen around the face and limbs. This is quite common when someone is critically ill and is caused by their inability to move, the treatments we give them for blood pressure, and having a machine controlling their breathing.

The nurses may try to reduce the effect by keeping the head of the bed slightly raised and the patient’s hands raised on pillows. The swelling usually reduces gradually as the patient gets better. Rings may need to be removed to protect the blood flow to the fingertips.

As a patient wakes up they may feel confused about where they are and what has happened, and may be anxious.

Sedation and medication can be used to relieve this, but this can make it difficult for a patient to think clearly.

Sometimes the combination of medication and being so unwell can change their understanding of what is happening and they may seem angry, hostile, or just different.

Patients who need a machine to support their breathing will not be able to talk, which can be frustrating for them. It is important visitors talk to the patient and, where appropriate, hold their hand. Sedated patients will often recognise a relative or friend by touch, or the sound of their voice, and be reassured.

Sedation can leave patients with a gap in their memory of that time. Some patients and visitors find it helpful to keep a diary of the patient's stay in ICU.

Hallucinations, delusions and nightmares

Patients who are sedated vary in how much they remember of their stay, but most can recall the days immediately after the removal of their breathing tube, although this may be fragmented.

Patients often have detailed memories of "un-real experiences" involving particular objects, nurses and emotions.

Discussing these memories later often reveals they are based on a misinterpretation of events happening around the patient at the time.

The memory may be frightening, pleasant or simply peculiar and “unreal”.

Please don’t be afraid to discuss these experiences with us. Rarely these may recur after recovery. Patients who develop issues with sleeping or hallucinations after returning home should contact their GP for help or advice.

Feeling weak and loss of weight

ICU patients may lose weight and muscle tone while critically ill. Joints may stiffen due to the long time spent in bed and there may be some loss of sensitivity in the fingers and other small joints. This can be distressing but, as patients grow more active, muscle weakness and joint stiffness will improve.

All ICU patients have physiotherapy, which helps to build physical strength and supports the rehabilitation process. While patients are recovering they often feel anxious and depressed about the effects of having been critically ill. We encourage patients to discuss these feelings with their relatives and with us.

Supporting someone in intensive care

There are a number of  ways to be involved in a patient’s care and recovery, but you are under no obligation to do any of these. Please talk to a member of staff if you would like any guidance.

'All About Me'All About Me board/rehab boards

For patients who have been with us for some time, we often find it is helpful to work with families to create a board for them to look at.

The board might include simple reorientation information, such as the date, time and place, or photos of family or pets.

The ‘All About Me’ charts record the patient’s likes and dislikes, hobbies, favourite songs, TV shows or any topics the patient is interested in.

Patient diary

Many patients' memories of ICU can be confused and incomplete. It can be useful to keep a diary for them to look through when they have left ICU and are feeling better.

The diary might include changes or progress in their care and treatment, and news about what has been happening at home.

ICU garden at Tunbridge Wells HospitalICU gardens

Our ICU gardens at Maidstone Hospital and Tunbridge Wells Hospital offer patients and their families (and sometimes even their pets!) a safe, tranquil place to spend precious time together. 

The garden lets patients have time away from the clinical area, so they are without the constant noises and beeps of medical devices. 

The space is also used by physiotherapy and occupational therapy teams for rehab, where it helps the patients to be in a different environment and creates as break from their normal routine.

Looking after yourselves and each other

Having someone you care about in ICU is a very stressful experience, with potential emotional traumas, and can take focus away from keeping yourself healthy.

Make sure to eat and take fluids regularly. Your GP may be able to support you with taking time off work or contacting psychological or other local support services. 

Our Chaplaincy team are here for everyone – patients, relatives and staff – whether you describe yourself as religious or not. They will listen to you, offer support and, if you wish, they can pray with you.

Leaving intensive care

Patients recovering from being critically unwell will hopefully be discharged onto a ward. 

This is a very positive step in recovery but it is natural for the patient to feel anxious about leaving ICU. We understand it can also cause anxiety for patients’ families. 

We aim to ensure safe transition of care. When a patient is discharged from ICU, all decisions are carefully considered by the multidisciplinary team led by a consultant. 

The responsible medical or surgical team will review the patient before they move to the ward. ICU nursing staff and therapists will talk to the ward team about the patient’s care and ongoing plans.

Patients will continue to be cared for by the multidisciplinary team.

Being very unwell can have lasting effects, and recovery from an ICU stay can be a long journey. Patients may also need support from community care teams after they leave hospital.

Follow-up clinic

We run a monthly follow-up clinic for patients who have been discharged from hospital after spending a long time in ICU.

It was set up by former patients and ICU staff and is run by doctors, nurses, physiotherapists, occupational therapists, dieticians and psychologists. 

The clinic helps patients who may face unique issues with their recovery from critical illness. It can help to build hope, regain confidence and reduce feelings of isolation.

Outreach

Critical Care Outreach supports the care of critically ill patients on the ward. Critical illness may be defined as a condition that is unstable and life threatening – a situation which can be distressing for patients and relatives.

Critically ill patients require high levels of nursing and medical care. The team provides a supportive service and work as part of the ward team, with the needs of patients central to all we do.

The team consists of critical care nurses who work closely with anaesthetists, physiotherapists, dieticians and nurse specialists.

Our aim is to promote optimum care for the critically ill by offering a service to assist ward staff in:

  • supporting patients and families at this difficult time
  • developing their critical care skills and knowledge
  • identifying patients who have become, or who are at risk of becoming critically ill
  • monitoring a patient’s condition both closely and accurately
  • securing early medical intervention in the event of any observed deterioration of the patient’s condition
  • obtaining rapid access to experienced medical practitioners if necessary
  • co-ordinating the transfer of patients to or from intensive care to ensure that critically ill patients are cared for in the safest environment.

Which patients benefit?

Any patient whose condition is causing concern to nursing, medical or physiotherapy staff such as:

  • a pre-operative patient whose condition is unstable
  • post operative patients following major surgery
  • medical patients with multiple illnesses
  • patients receiving help with their breathing
  • trauma patients who have multiple injuries
  • patients who have been discharged from intensive care
  • patients with specific conditions such as pancreatitis which make them very unwell
  • patients with tracheostomies (neck breathers) who are not being nursed in intensive care or the ENT ward;

Following ward referral, we will discuss the patient’s condition, situation and other relevant factors with the nurses and doctors looking after the patient. 

 We will also discuss concerns about the patient and offer advice. The Outreach team supports the critically ill patient on the ward by:

  • ensuring that the necessary monitoring equipment is obtained
  • facilitating further investigations or actions as directed by the doctor
  • ensuring rapid response by senior medical staff if necessary
  • facilitating transfer of patient to intensive care/theatres/other hospitals as appropriate
  • offering advice or teaching for nursing staff as requested

The team also visits the ward daily to offer their support and register patients the ward wish to designate as outreach patients. We ensure the site practitioners and the anaesthetic teams on call at night are aware of the condition and location of these patients.

Who refers patients?

Any nurse, health care assistant, doctor, physiotherapist, dietician or clinical nurse specialist who has assessed the patient can refer them for Outreach support.

The professional judgement of the person at the bedside is the most important factor in assessing and identifying critical illness. The nurses and doctors call us to assist them in making that judgement.

Visitors and patients can also request an outreach nurse to see them should they feel that the patient fulfils the relevant criteria.