In the October segment of our #InConversation LIVE series, we spoke with Dr. Mayank Uppal, Consultant, Internal Medicine at Sitaram Bhartia Institute of Science and Research to understand the intricacies of critical care.
Watch the video below or read on.
When would someone require intensive care?
Any patient who is acutely ill, whose vitals are unstable or is heading toward a life-threatening situation would require critical care, wherein interim, closed monitoring care is provided until the underlying condition is treated effectively.
Does every hospital need to have an intensive care unit?
It is a must for every hospital to have critical care services because even though a patient may be admitted in general wards for their illness, any sudden deterioration in their condition warrants close monitoring and attention. The first few hours and a couple of days are very important in deciding the course of the patient’s disease and recovery. And if close close support and intensive care is available and provided effectively in the first 24-48 hours, the outcome is widely different as compared to patients who may not have access to such care in the first couple of days in the deterioration of their condition.
What kind of super specialty care is provided to ICU patients at Sitaram Bhartia?
Intensive care is not a standalone specialty. It is an amalgamation of different specialties that provides one cohesive approach toward treating the patient. There are different teams that are involved in the patient’s care but the decision making is done together. The different teams at Sitaram Bhartia include Pulmonary and Critical Care Medicine, headed by Dr. J.C. Suri and Dr. Ayush Gupta; the Internal Medicine team (Dr. Mayank Uppal & Dr. Kartikeya Kohli) and our team of intensivists. We also have support from super specialities like gastroenterology and the provision of 24 hour endoscopy, nephrology in the form of continuous renal replacement therapy and dialysis available 24*7 for patients admitted in the ICU. There is also bedside bronchoscopy for patients admitted in the ICU.
How is the intensive care provided at Sitaram Bhartia different?
We follow international guidelines of care, for both consultants and nurses, including our nurse to patient ratio, hand hygiene and infection control practices, that are the basic foundations of critical care.
We understand that critical patients have a great impact on families in terms of a fear of separation aside from a financial impact. We try to help families by giving them regular access to their loved ones admitted in the ICU, keeping in mind infection control practices. They also meet the treating doctor twice a day, and we answer all their queries, doubts and anxieties. Our nurses are also available at the bedside when family members visit the ICU and are available to answer any basic queries they have, such as whether the patient has been eating well or passing stool etc. These small things go a long way in keeping the patients and their families motivated and help lessen their anxiety.
We are also transparent in sharing the treatment with family members in case they require it.
We also have regular multi-disciplinary team counselings which comprise a super specialist/intensivist and an internal medicine doctor to go over the patient’s progress and involve the patient’s family in their care.
How can families of ICU patients cope with the situation?
There is no one straight answer as all patients are different and their condition and subsequently treatment would differ from one another.
We understand that family members go through a lot of doubts and anxiety when their loved ones are admitted in the ICU. We would recommend all family members to:
- Note down your queries before you meet the doctor because in the time that you spend with the doctor, you may not be able to recollect all the questions you had. Any unanswered doubts may then linger on and cause more anxiety, so it’s always good to jot down all your questions so that your doctor can systematically answer all your questions there and then.
- Be transparent about your medical history and bring in any previous reports during your discussions with the doctor as these prove helpful in assessing the current situation and determining the future course of treatment.
- Be patient even though it’s hard.
What has the second wave of COVID-19 taught us in terms of improving our standards of ICU care?
The second wave brought on unprecedented volumes of patients that stretched not just government hospitals but also private hospitals in terms of the facilities they could offer.
The second wave taught us about rationalizing resources, similar to triaging patients, which is a practice we’ve followed since long in our emergency department, even prior to the COVID-19 pandemic. This helps us to determine who needs admission and where, in the sense of ensuring that someone who requires critical care is not admitted to the wards and vice versa.
The nurses and duty doctors in the emergency were already in tune with the system so that made it a little bit easier for us to assess who needed ICU admission.
Even when patients are admitted in the ICU, we do a daily assessment and reassessment to see whether they still require ICU stay or whether they can be shifted to the ward. These assessments are openly shared with the family members in the ICU rounds so as to share what has changed in the last 24 hours, why the patient still needs to be in the ICU if required or whether the patient can be shifted to the wards. This gives the family a sense of clarity and control of the patient’s care.
How important is the role played by nurses in critical care?
Nurses are the backbone of healthcare, especially with respect to critical care. She is by the patient’s side 24*7, monitoring the patient, assessing even the most minor changes, aside from giving them food and medicines, turning the patient and following infection control practices.
Our nurses are trained and re-trained and they are all accredited by the Indian Society of Critical Care Medicine, which helps us to provide not just competent but also compassionate care to our patients.
Is it common for patients who have been advised ICU admission to get a second opinion about it?
It is common for family members to get a second opinion to understand whether intensive care is really required. We would suggest family members get a medical summary from their treating doctors to help us decipher the patient’s condition and what can be done best for the patient.
In our setting we don’t see many patients who want to take a second opinion from other places because there is a lot of clarity along the way.
We hope you enjoyed this segment of our #InConversation LIVE series with Dr. Mayank Uppal on Critical Care. Don’t hesitate to get in touch with us at +918800816657 to consult Dr. Mayank or to get a second opinion.