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Los Pollos Hermanos
04-01-2014, 02:27 AM
I'm hoping that (once more) you marvellous people will be able to help me out with a few small details, pretty please.

Setting: Private room off a surgical ward in a Nevada (not Vegas!) hospital. Female mid-30s patient has been out of emergency surgery (post-stabbing laparotomy to repair a perforated bowel, and a subsequent miscarriage) for ~7 hours and is in a stable condition. I'm quite secure on the overall medical details thanks to a UK doctor source and the aforementioned marvellous people on here.

Assuming it's a little before 8.00am, what kind of activity would there be in this type of ward at that time? Not just with my patient, but with others nearby? I could easily find out if my setting was a UK hospital but I'm aware that things are sometimes done differently across the Pond.

Also, as the patient has recently come out of emergency surgery, would her husband be allowed to sit with her overnight? She sleeps off the anaesthetic and is then drowsy because of painkillers. I know ICUs generally have no set visiting times, but that wards tend to do so.

I don't need the nitty gritty, just enough to make her surroundings realistic whilst she starts to wake up properly and her and her husband have a relatively brief conversation. Satisfied it looks as if she'll be OK, he'll then leave (with his boss - they're both in law enforcement - boss needs to keep the patient's hubby off the case - ha!) to let her get some rest.

Many thanks in anticipation,

LPH.

MDSchafer
04-01-2014, 03:20 AM
Depends on the facility, depend on the wound. If she's stable after emergency surgery she could go straight from the PACU to a med-surge floor without passing through the ICU, but again this can vary greatly. I don't work in a level one trauma center so I'm not an expert on how this sort of thing would play out.

The biggest difference patients see with the ICU and a med-surge floor is that in the ICU all the doors and walls facing the center of the unit are glass and there is a nursing station in the center so that the nurses can observe all of the patients at all times. On a med surge floor in America pretty much every room is a private room in every hospital.

By 8 a.m. shift change should have already happened, breakfast trays should start waking up. In the ICU the nurse would notice she's awake and start their assessment. On Med-Surge she'd be in a quiet room until either a nurse, tech or food services came in.

In America we don't use "Wards," everything is either a floor, unit or department. The slang typically tends to refer to your unit as the floor number. Like 10 Tower or 10 West.

Overnight stays? Perfectly acceptable in med-surge, and in the ICU it probably varies based on facilities. Also, there are different rules for cops. I can't imagine my facility telling a police officer whose wife has just miscarried because of an attack where he is not a suspect in, that he has to wait in the ICU family room, but every facility is different.

Los Pollos Hermanos
04-01-2014, 03:58 AM
Many thanks for such a detailed reply!

The hospital in question is a medium-sized facility based on the real one in the area. According to the hospital's website, it's a level 3 trauma center, but on cyber-paper it seems pretty damn decent when compared to some of our hospitals!

Thanks for the heads-up on the "wards" business - I'm generally not too bad at American English as I've had to do loads of reading/listening research for the American characters' dialogue, but it's those little slip-ups which grate (e.g. the Irish author whose American main character referred to leaving her Jeep in a "car park" in Breckenridge - I've been there twice, and I only noticed parking lots! ;) ). The other half of the story is set in England (with a brief European jaunt), which is considerably easier to write the dialogue for. Anyway, I digress.

I don't want a big medical drama to overshadow the final quarter of the story where Mr Bad Guy gets caught. Hence I'd like to have her in a stable condition asap and in a medical-surgical unit, rather than in an ICU if possible/realistic. Hubby isn't a suspect, btw. In addition to a watertight alibi, the police and FBI (BG has got form in five different states, including killing one of their agents) are pretty much certain Mr Bad Guy is behind it.

So, say she's on the m-s floor... random question... would the rooms' internal walls and doors have blinds at the windows? I've done three research visits stateside, but snooping around hospitals wasn't an option!

Finally, there's a much earlier scene in a big city hospital (with a level 1 trauma center) where a victim is in the neuro-ICU. Would that unit be a open space or would there be separate rooms (with glass "walls" - if that makes sense)?

Huge thanks,

LPH.

melindamusil
04-01-2014, 04:40 AM
Disclaimer- I'm not a medical professional at all. My experience comes from being IN the hospital, both as a patient and visitor.



So, say she's on the m-s floor... random question... would the rooms' internal walls and doors have blinds at the windows? I've done three research visits stateside, but snooping around hospitals wasn't an option!

I would say, most likely, yes. People 'round here are pretty big on privacy. That's why most of the hospital rooms are private rooms - generally speaking, the only exceptions are in older hospitals (built before ~1970), and even then they usually only double up if they are swamped with patients. In addition to a private room, patients will want to be able to close the door/blinds when they are changing clothes, or if they're being examined by a doctor.



Finally, there's a much earlier scene in a big city hospital (with a level 1 trauma center) where a victim is in the neuro-ICU. Would that unit be a open space or would there be separate rooms (with glass "walls" - if that makes sense)?

I'm speaking out of my own experience here. When I was 17, I was in a car accident and taken to a Level 1 trauma center with a traumatic brain injury (among other injuries).

First, if I was reading, I'd probably be kinda surprised that he was in a neuro-ICU, as it's my understanding that neuro-ICUs are not terribly common. However this is probably not something that the average person would know. At "my" hospital, there was a cardiac ICU and a surgical ICU. I was in the surgical ICU.

Finally... at "my" hospital, I would describe each ICU as a semi-circle. The nurses' desk was at the center of the circle, and the patient rooms were around the edge (so the nurses could "see" everything). Walls were made of glass (or some kind of clear stuff). Doors were extra-wide, as most people who came into the ICU were unconscious or otherwise bedridden. The rooms also had curtains that could be pulled around the patient when a doctor was doing an examination. They were pretty good about respecting privacy, but unless a doctor or nurse was in the room, the curtains stayed open.

Oh, and as far as visitors and visiting hours- there were "technically" rules about visiting hours and number of visitors and stuff, but the nurses were given wide leniency in the enforcement. This was in both the ICU and the general units. This was largely because the hospital was in a bad part of town and had to deal with a lot of unsavory types. So, if a visitor started to get rowdy, the nurses could kick 'em out, but as long as the visitors were quiet and stayed out of the way, it was no big deal.

MDSchafer
04-01-2014, 04:54 AM
Whether a level 3 trauma center could preform an emergency laparoscopic repair is something I don't know. I work in a major city where the preference would be to transfer them to a larger hospital. Does that really matter to your story? I wouldn't think so.

Yes, Med-Surge rooms have doors, that don''t lock, and blinds on the window. Some people are in them for a month or more at a time. Typically there is some sort of curtains available in the ICU. But like I said earlier once you get out of the ER pretty much every room in a hospital is a private room.

All ICU's I've ever been in have glass walls facing the nursing station. Some are panels with doors, and others are just a massive pair of sliding glass doors.

The other thing to consider is that if he's a local cop the other officers and their families are going to rally around them. They're not going to leave the wife alone and they're not going to leave him by himself either. Police understand what it means to look out after their own.

Los Pollos Hermanos
04-01-2014, 10:28 AM
Double thanks to you both!

A quick mention about the neuro-ICU thing. I picked the brain (pardon the pun) of a consultant anaesthetist I know. He's orginally from London (but I don't hold it against him... ;) ) so is used to big hospitals with specialisms. I originally had the victim in a surgical ICU in my big American city hospital because he had multiple injuries, but the doc said if there was a neuro-ICU that's where the victim would be. I did some googling and the hospital has one.

@ Melindamusil - Many thanks for the insider ICU info. I use artistic licence with the interiors of public buildings, but like a healthy dash of realism. I hope you're all fully recovered now.

@ MDSchafer - Many thanks for all the snippets of goodies about room/unit layouts. Over here they've generally got rid of the huge wards my Mum encountered in her 60s/70s nursing career, but these days four to a "room" on the ward is pretty commonplace. The patient's individual area has curtains to pull around the bed, but the overall experience is still like being in a goldfish bowl.

The smaller hospital I'm currently using in a completely different part of the country to Big City has the most rammed full of useful info website ever, especially when compared to the big city hospital's. It performs emergency surgery as patients can be air-lifted in, has a medical-surgical floor, lots of private patient rooms and even a small ICU.

Finally, am I correct in understanding that what we call high dependency units (where a patient may be transferred to once they're well enough to leave ICU) in the UK are called step-down units in the US? I've mentioned an SDU in passing, but it's not really part of the story.

Massive thanks!

LPH.

p.s. Hubby (and wife) aren't local to the area, but work locally - which is a whole other story in itself. His boss is keeping an eye on him (mostly to stop him going off and looking for Bad Guy!) and the family are being taken care of by another member of their team.

MDSchafer
04-01-2014, 04:39 PM
The place I work doesn't use the step down term, but again it varies from facility to facility. I've heard it called intermediate care, I've also heard it called progressive care and acute care. The defining characteristic seems to be if they're on a vent, or need sedation. If you use the term step down I don't think it would read weird.

Los Pollos Hermanos
04-01-2014, 09:40 PM
Cheers for the extra info. :D

I've used the term Step Down Unit for the big city hospital, because that's what they refer to it as on their website. I understand it to be for patients who are too well to be in ICU, but too ill/sick to be on a "ward" - or equivalent terminology.

Thanks again,

LPH.

p.s. Is it always called a PACU in the US? I've heard the term before, but have never used it in the UK. We tend to call it the Recovery Room. Is PACU a formal term only and, if so, is there a more informal term for that particular type of unit in the US? (it'll be referred to in conversation).

melindamusil
04-01-2014, 09:54 PM
A quick mention about the neuro-ICU thing. I picked the brain (pardon the pun) of a consultant anaesthetist I know. He's orginally from London (but I don't hold it against him... ;) ) so is used to big hospitals with specialisms. I originally had the victim in a surgical ICU in my big American city hospital because he had multiple injuries, but the doc said if there was a neuro-ICU that's where the victim would be. I did some googling and the hospital has one.

That's cool. Like I said, it would surprise me - but it also wouldn't shock me, if that makes sense. Neuro-ICUs are not "common", but given the large number of hospitals in this nation, they are common enough.



@ Melindamusil - Many thanks for the insider ICU info. I use artistic licence with the interiors of public buildings, but like a healthy dash of realism. I hope you're all fully recovered now.

Thanks. Yes, I am recovered, and I will be eternally grateful for the wisdom of the doctors who took care of me. :) If you have any other questions about the experience of being the hospital patient, feel free to PM me. (Also if you have any questions from the family side - neither of my parents work in medicine, and they were with me throughout my hospital and rehab time.)



p.s. Hubby (and wife) aren't local to the area, but work locally - which is a whole other story in itself. His boss is keeping an eye on him (mostly to stop him going off and looking for Bad Guy!) and the family are being taken care of by another member of their team.
It is definitely not impossible that police officers and their families in another department would offer support to your characters. There's definitely a brotherhood between them. If there is a wife of a police officer who likes to be a "hostess", or a police officer who may have worked with Hubby years ago, it's definitely possible that they might stop by and try to give Hubby a break so he can go get something to eat or take a shower. But this could go either way, so do whatever works for your story.

melindamusil
04-01-2014, 10:02 PM
I've used the term Step Down Unit for the big city hospital, because that's what they refer to it as on their website. I understand it to be for patients who are too well to be in ICU, but too ill/sick to be on a "ward" - or equivalent terminology.

One other thought on the visitors that you kinda mentioned above - when I was in the hospital and was transferred out of the ICU and onto a "ward", the nurses really welcomed letting my parents stay with me 24/7. I don't think this hospital had a "step down unit", or maybe there just wasn't room in it. I was too well to be in the ICU, but because of the brain injury, my behavior was still fairly unpredictable and I needed a lot of supervision. Nurses in the ICU were only assigned 1 or 2 patients, so that level of supervision was ok for them, but on the "ward" they were assigned anywhere from 6-12 patients, so having my parents there to keep an eye on me was a big help.



p.s. Is it always called a PACU in the US? I've heard the term before, but have never used it in the UK. We tend to call it the Recovery Room. Is PACU a formal term only and, if so, is there a more informal term for that particular type of unit in the US? (it'll be referred to in conversation).
You know, I've heard the term PACU, but just talking among people, I would usually call it the recovery room or just recovery. Like, "The surgery went well. Bob's in the recovery room now." Or "Bob's in recovery now."

juniper
04-01-2014, 10:12 PM
Hi, I work in a community hospital on US west coast. We're not a trauma hospital - those cases that come in are stabilized and sent on to our sister hospital about 7 miles away. We have about 80 inpatient beds, with 29 more in ER.

Emergency is on 1st floor, along with lab, other medical offices, admin offices, etc. 2nd floor is surgery, PACU (used to be called recovery, now is Post Anesthesia Care Unit), and short stay (day surgery). ICU is also on 2nd, must be buzzed in, glass door on each room, patients always visible to nursing station. 3rd flood is mostly medical care, each patient has a separate room with doors and private bathrooms (toilet/sink/shower), any windows to the hall have blinds. 4th floor is mostly for pre-and post-surgical care, although some med patients may be roomed there too.

ICU is expensive, so stays are limited to those patients who actually need round-the-clock monitoring and one-on-one or two-on-one nurse/patient ratio.

Standard visiting hours are noon-8pm, although that's not really enforced. After 8pm visitors come through the ER and are given passes to go upstairs, unless there's a "no visitors" note on the account. That includes ICU - if the patient is unstable or it's late at night, we call ahead to see if visitors are ok at that time.

Also - some visitors are flagged as "no info" which means they are not listed in the hospital online directory - so only some employees can see their names/room numbers - also that means we do not give out any info on that patient. If someone phones or comes in to ask about a "no info" patient, we say, "I'm sorry I have no information on a patient by that name." And we repeat it over and over until we have to call security to escort the visitor out. The "no info" flag is usually at the patient's request, although can also be put on at charge nurse request or family request. The "no info" is total - even for family (spouses too) and police etc. with few exceptions.

In the scenario you're describing, the patient would most likely be marked as "no info" for visitors, although of course the law enforcement would be aware and most likely would be allowed in. In our hospital, police and other official-types do not have free run. They are treated as any other visitors, unless they have arrest papers or court orders (sometimes happens that patients in ER go directly to jail).

Hope this helps some. I don't remember all your questions. (sorry)

ETA: melindamusil is right, most visitors would say "recovery room" rather than PACU.

MDSchafer
04-01-2014, 10:12 PM
p.s. Is it always called a PACU in the US? I've heard the term before, but have never used it in the UK. We tend to call it the Recovery Room. Is PACU a formal term only and, if so, is there a more informal term for that particular type of unit in the US? (it'll be referred to in conversation).

PACU is more of an industry term. Most patients will just use recovery.

Los Pollos Hermanos
04-02-2014, 12:01 AM
Triple thanks for all your help so far, offers of additional help and the general kindness!

I've been using the term "recovery (room)", so that's a relief. :D I'll soon be doing the Big Edit when I've finished, so that'll be an ideal opportunity to tidy/tweak any errant UK-style hospitalisms (is that a new word?!) for the occasional medical-ish parts of the story.

Interesting about the "no info" rule - the press are sniffing around for a bit of scoop (small-ish town, but not in a Deliverance way) for the next edition of the local rag. Currently her husband is allowed in, but his boss is in the waiting room keeping an eye on him! Her mother will be flying in later on the day after the incident which put her in (the) hospital.

Actually, that reminds me... In the UK we say "He was in hospital", rather than "He was in the hospital". Would Americans say "He was in the ICU", rather than "He was in ICU" like we'd say in the UK?
I type the story in British English but, whilst I keep "my" spelling rules in the US-based parts, I'll use American terminology (e.g. first floor instead of ground floor, cell phone instead of mobile phone) to make it a little more authentic.

You people are the best! :Hug2:

LPH.

juniper
04-02-2014, 11:02 AM
Would Americans say "He was in the ICU", rather than "He was in ICU" like we'd say in the UK?


I had to say it out loud to recollect what I say. It's, "She in ICU, on the 2nd floor." Or, "She's in Short Stay" or "She's in PACU (or recovery)."

Not "the ICU, the short stay, the recovery."

Maybe because they're nicknames for the whole phrase? Because I might also say, "She's in the Intensive Care Unit." "She's in the Short Stay section." "She's in the recovery room."

And remember, when I say 2nd floor, you'd probably say 1st floor. 1st floor to us is ground floor to you, I think.

Los Pollos Hermanos
04-02-2014, 08:00 PM
Cheers again. I just wondered if the the thing crept in elsewhere - I shall stick to "S/he's in the intensive care unit" or "S/he's in ICU" in the dialogue.

I can cope with the UK vs US floor numbering thing after an embarrassing incident in New York during my first transatlantic jaunt. After some unfortunate Macy's assistant finally worked out that I wanted "sweatpants" (we have all manner of weird words for 'em here - trackies being my preference) he directed me to the second floor... well, you can imagine where I ended up! :Shrug:

Best wishes,

LPH.