What happens circa 8.00am in the surgical ward of a US (Nevada) hospital?!

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.

Disclaimer- I'm not a medical professional at all. My experience comes from being IN the hospital, both as a patient and visitor.

Los Pollos Hermanos said:

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!

Click to expand...

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)?

Click to expand...

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.

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.

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 said:

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.

Click to expand...

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.

Click to expand...

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.

Click to expand...

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.

Los Pollos Hermanos said:

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.

Click to expand...

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).

Click to expand...

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."

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.

Los Pollos Hermanos said:

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).

Click to expand...

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

Los Pollos Hermanos said:

Would Americans say "He was in the ICU", rather than "He was in ICU" like we'd say in the UK?

Click to expand...

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.