The Medical High Dependency Unit (MHDU) at St. Peter’s Hospital has been up and running for 12 months. (Feb 1st) And the staff have much to celebrate,  and although it is not in their nature to sing their own praises they are happy to mark the event knowing that many families they have helped would wish them to do so. 

The four-bed unit is staffed by 13 nurses, of which nine are critical care specialists, with a ratio of one nurse to every two patients. They have a designated medical team to look after the unit and the clinical lead is Consultant Physician in Respiratory Medicine Dr Paul Murray. His two consultant colleagues, Dr Mark Britton and Dr Michael Wood take it in monthly turns to have daily responsibility for the ward. The Consultant with his Registrar, Senior House Officer and House Officer all take part in a morning “round” each day together with the nursing staff, member of the intensive care “outreach” team and a physiotherapist.

The Registrar, SHO and HO and nursing staff “manage” the care of the patient throughout the day and the whole team re-group in the early afternoon to discuss every patient once more.  It is the Consultant or his Registrar who acts as the “gate-keeper” and decides which patients should be admitted to the unit.  If another Consultant thinks a patient needs to be admitted the Registrar will visit the patient on the other ward and review the patient to see if the Medical High Dependency Unit is the appropriate place for their continuing care.

Patients are admitted from other wards, the medical assessment unit (MAU) and A&E.  Some will also be transferred from the Intensive Care Unit (ITU). This “stepping-up or stepping-down” process is overseen by the outreach team who ensure a smooth hand-over of the patient and their medical history when they are admitted to the HDU or are moved to another ward or unit.   The out-reach team continues to follow them up until they leave hospital and their care with their GP is in place.

Said Dr Murray: “It became obvious that there was a need for a dedicated medical high dependency unit,  in the greater part due to the increasing number of patients with chronic obstructive pulmonary disease (COPD) who needed non-invasive ventilation as a first line of treatment.

“There was a need for some patients to be “stepped-down” into an HDU following intensive care treatment. We were also aware that there were some very ill patients on medical wards who need a “step-up” in care which can be provided by a high dependency unit. The patients have benefited as they are being cared for by a designated team with specially trained nurses. There is the added benefit of the HDU reducing the workload and pressure on the medical unit as a whole.”

The Sister-in-Charge of the MHDU, Dawn Reeves-Turner began specialising in critical care at St. Richards Hospital,Chichester in 1987. She moved to Ashford Hospital in 1994 in the pre-Tesco days - when patients had to be moved on an outdoor route between the intensive care unit and wards. All of her nursing team have worked together at Ashford in ITU in the past and they were all involved in the planning, drawing on their vast experience of critical care, prior to the unit’s opening.

She had a big in-put into the design of the MHDU, not only the lay-out but from the way infection control is tackled.  The unit is spacious with overhead mover-track for the bedside curtains which allows for flexible, bigger space between the beds depending on what equipment is being used. When a bed become vacant only the monitor, suction and oxygen equipment remain at the bedside and the cleaned bed area remains empty until the new patient arrives, together with their appropriate equipment.  The bedside curtains are made of paper, and disposed of every four months.

Said Dawn: “Our team have all grown up together in ITU and we are “obsessed” with infection control.  We are proud of our really low rates of infection..  All visitors are made aware of our hygiene rules and understand why they have to wear protective disposable aprons and use the alcohol-rub for their hands.”