Admission to intensive care

Admission to intensive care is an important and distressing time for family members, who often have to wait a long time, sometimes several hours, before seeing the patient or receiving information from the healthcare team. Here is why.

Arrival

When a patient is admitted to intensive care, the team must settle them into their room, assess their condition and connect the equipment required for their needs. This means setting up monitoring and, where necessary, organ support. Even before reaching the intensive care unit, the patient may be taken for tests or emergency procedures, such as a CT scan, coronary angiography or treatment in a resuscitation area. This can make the wait even longer for family members.

Once the patient has arrived in their room, the doctors examine them and, if they are able to answer, ask all the questions needed to assess the situation as fully as possible.

At the same time, nurses and healthcare assistants settle the patient in, change them into a hospital gown, attach electrodes to monitor their heart and take a number of measurements and samples, including temperature, blood pressure and blood tests. A urinary catheter may also be inserted.

For the patient, this can be an intense and stressful time: they are transferred from the stretcher to the bed, many healthcare professionals work around them, several technical procedures are carried out and they are asked numerous questions. Things become calmer once the patient is comfortably settled, all the monitoring equipment needed for their condition is connected and the urgent assessments have been completed.

While waiting to visit the patient or speak to the medical team, family members can begin completing the administrative formalities to save time. During office hours, you can go to the intensive care unit’s reception desk with the patient’s health insurance card, supplementary insurance details and an identity document.

You can also gather any information you have about their health, such as prescriptions, medical reports and recent test results.

The patient’s first hours in intensive care

The description below concerns the most critically ill patients: those experiencing shock, meaning a very serious condition caused by severe bleeding, a serious infection, a severe allergic reaction or heart failure; those at high risk of developing shock; or those admitted in a coma. Not every patient requires all of these treatments.

If the patient arrives already intubated and receiving mechanical ventilation, an X-ray is taken to check that the breathing tube is correctly positioned, and the ventilator is adjusted according to the results of blood tests, including blood gas analysis. If the patient is not intubated but urgently needs to be, the procedure is performed quickly, although it may still take some time. The necessary equipment and a sufficiently large team must be brought together, while the procedure is explained, the patient’s consent is obtained and, if they are conscious, they are reassured.

If necessary, catheters are inserted at the same time. These often include a central venous catheter, which provides safe central access for certain medicines, and an arterial catheter, which continuously monitors the patient’s blood pressure. These procedures are carried out under sterile conditions, with extremely strict hygiene precautions. The doctor must wash their hands thoroughly, put on a mask, surgical cap and sterile gown, and place sterile drapes before inserting the catheter. All of this can take some time, often several tens of minutes for each catheter.

Once these procedures are complete, nurses and healthcare assistants quickly tidy the intensive care room and reposition the patient so that the first sight family members have on entering is as reassuring as possible. At the same time, the doctors review the results of the blood tests taken earlier and go through the medical record to clarify the situation and any remaining uncertainties.

Only at this point, once the patient is settled and the situation is as safe as possible, can the team take the time to meet the family, explain their current understanding of the situation based on the information available, ask any outstanding questions and then take them into the patient’s room.

Katia’s story
Admission to intensive care

The initial meeting with the family

During the initial admission meeting, it is helpful for the healthcare team to gather key information from the patient’s family. This includes what they currently understand about the situation and any possible causes, as well as the patient’s usual treatment and medicines, lifestyle, occupation or daily activities if retired, smoking or other addictions, and level of independence in everyday life. The team will also ask whether the patient has advance directives and about their interests, preferences and hobbies—in short, anything that can help personalise their care as much as possible.

There is usually still considerable uncertainty during this first meeting: not all test results are available, not every possibility has been confirmed or ruled out, and the more unstable the patient is, the less certain the team can be about how their condition will develop over the following hours. This uncertainty is very difficult for family members, and the healthcare team is fully aware of this, but at this stage they are usually unable to provide definitive answers. This uncertainty may last for several days, and in some cases several weeks. Please be assured, however, that the healthcare team will keep you informed of any changes in the situation.