Caring for the critically ill: pediatric intensive care at the IWK

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“I think people often think of the intensive care unit as a scary place. When resident trainees first come to the ICU, they all remark it’s a different way of thinking about patients. The way that we talk to each other, the way we present patients, it’s different,” says Dr. Jennifer Foster, IWK intensivist, adding that “In PICU, you never know what’s coming through the door.”

Foster reflects on her work in the Pediatric Intensive Care Unit (PICU) together with colleagues Hailey Fudge, interim clinical leader development, Barb Ellsmere, redevelopment project clinical lead and Laura Betts, manager. Collectively, along with all their colleagues, they care for some of the IWK’s most critically ill patients.

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L-R: Dr. Jennifer Foster, Barb Ellsmere, Hailey Fudge, Laura Betts

The PICU team is diverse with staff from many disciplines: physicians, nurses, pharmacists, support staff, social workers, dietitians, physiotherapists, respiratory therapists and child life specialists.

“What we provide is not only technology, but a full team of care, and our staff are trained differently. Some people think ICU care is just the ventilator or just the medication, but our nurses and allied health staff are trained differently too,” says Fudge.

PICU staff also work as a bigger team with EHS/IWK Critical Care Transport to expand their service far beyond the walls of the IWK. Of the 450 patients the IWK’s PICU sees annually, nearly 50 per cent are from outside of Nova Scotia, and many of those from the province are not local to Halifax.

“Critical care services for children in the Maritimes are localized to the IWK. We can’t move the PICU, so we have to have transport abilities. To try to get a critically ill child from the top of Cape Breton down to Halifax is a pretty big deal so we provide telephone advice and send out the transport team, which is a specialized nurse-respiratory therapist configuration team who can provide mobile ICU services,” says Foster, adding that “I’ve worked at a lot of ICUs around the world, and this is the best transport team.”

In addition to providing highly specialized care for patients, ICU staff also support families at one of the most stressful times in their lives, something the team at the IWK excels at.

“We talk about organs failing but I think PICU does an exceptional job at holistic care. We look after patients’ and families’ psycho-social needs really well,” says Ellsmere. Fudge echoes that, saying “I’ve had allied health staff that work in other areas say to us that PICU does family-centred care particularly well, even in situations that may make it much more difficult to practice it.”

As a manager, Betts witnesses her team coming together for their patients and families day in and out. “I think that’s what makes me the most proud because even though we’re all fantastic at doing our critical care work and providing patient care, we take the time to make sure the families are taken care of, as well as take care of each other.”

Like most departments in the health centre, it’s teamwork and collaboration that lead to the best outcomes.

“I think of ICU as very much a team sport. It only functions well because it is a very multidisciplinary team,” says Foster.

IWK PICU staff are a dedicated and selfless bunch, relying on their colleagues when needed, and offering support in return.

“We pull together really well when times are busy and tough,” says Betts. “People really go above and beyond to make sure were providing the best quality care that we can.”

“The best thing about ICU, and the reason many of us love our jobs, is that most kids get better,” shares Foster, with Fudge quickly adding “I don’t want to say miraculously so but sometimes almost against all odds it seems.” “They’re so sick, and sick so quickly, but then most do recover,” Ellsmere notes.

“It’s so satisfying when a patient who was incredibly sick when we met them, even on death’s doorstep, comes back later to visit and we can really see why we do our jobs,” says Foster.

October 21-27 is Canadian Intensive Care Week 2018.