Critical Care at this hospital includes these wards
Critical Care also includes these services
Critical Care is for patients who are so acutely ill that their life is in imminent danger because one or more of their organs have acutely failed or are at risk of failing.
Critical Care is also for patients who are at risk of organ failure because they have had a high-risk operation (high-risk either due to the nature of the surgery, or due to the patients’ chronic health).
Critical Care patients’ vital signs are constantly monitored. Some of the treatments in Critical Care involve using machines (e.g., a ventilator or “life-support machine”) which keep someone alive while one or more of their own organs are unable to.
The Critical Care staff have specialist training, and there are more of them per patient than in other areas of the hospital.
Being a Critical Care patient can be a very traumatic experience. For this reason, we are careful only to put somebody through this experience if they have a chance of getting better with the treatment. We do not put somebody through this treatment if it is very unlikely to help them get better. The decision-making around who and when to admit someone to Critical Care is done by senior specialist doctors (Consultants) and, whenever possible, in discussion with patients and/or their close family.
Please see this link for a video of people describing what it was like to be a Critical Care patient.
Critically ill patients require support for failing organs. In the Intensive Care Unit this could include:
Post-Operative Critical Care (the POCCU unit) is specifically for patients who are at risk of organ failure or require additional support because they have had a high-risk operation (high-risk either due to the nature of the surgery, or due to the patients’ chronic health). Enhanced recovery pathways are utilised to improve patient outcomes after complex major surgery. Interventions that have a strong evidence base for improving patient outcomes, such as goal directed fluid therapy are also utilised.
High Dependency is a slightly level lower of dependency, for patients who require support for one organ and continuous close monitoring, either due to acute illness or after surgery.
Both ICU and HDU are run by a team of Consultant Intensivists (a senior doctor specially trained in managing critically ill patients), trainee doctors nurses, pharmacists, and specialist therapists, all of whom will have experience in looking after extremely ill patients.
Formal Consultant Intensivist ward round takes place twice daily at 09:00hr and at 16:30hr. During this ward round doctors and nurses discuss the patients’ progress and care, examine the patients, decide on further treatment, and make a plan for the rest of the day. This ward round includes input from other specialist consultants, including microbiologists who specifically advise on infections
Following discharge from the ICU and HDU, patients have ongoing support from our specialist Outreach team of nursing and physiotherapy staff. The team provides ongoing specialist rehabilitation care as well as a support structure to support patients and their families, as they recover.
Our 3 Critical Care wards admit up to 2500 patients a year. They include planned admissions after elective high-risk surgery, unplanned admissions after emergency surgery, people with medical emergencies eg pneumonia, COVID, seasonal influenza, or sepsis.
We are also a regional specialist centre for infectious diseases, acute pancreatitis, hepatobiliary surgery, upper gastrointestinal surgery, vascular surgery and thrombotic thrombocytopaenic purpura; patients are often transferred from other hospitals to us.
We directly support the nearby regional specialist obstetric hospital (Liverpool Womens’ Hospital), and the regional cancer hospital (Clatterbridge Cancer Centre-Liverpool).
We work as a team of nurses, doctors, physiotherapists, speech & language therapists, dieticians, pharmacists, occupational therapists, operating department practitioners, healthcare assistants, a clinical psychologist, as well as our managers, audit clerks, and administrators.
The team includes:
Over 180 Nursing staff and Healthcare Assistants
The ITU is staffed by approximately 130 nurses and 9 health care assistants. HDU have approximately 70 nurses and POCCU 25.
All of our nurses are highly trained and undergo a thorough precentorship period, supported by our practice educators. They complete a number of competencies, set out by the critical care network, which ensures they meet the standards required to safely look after critically ill patients. Critical care staff receive ongoing training and education, which ensures the delivery of care is maintained at the highest quality.
The nursing staff are responsible for planning, managing and evaluating the care of critically ill patients, working with medical colleagues and other members of the multidisciplinary team.
25-30 Training Grade Doctors, including Advanced Clinical Fellows, Specialist Registrars, Junior Clinical Fellows, Academic Research Registrars, Core Trainees, Foundation Doctors.
6 Critical Care Outreach (CCOT) Nurse Clinicians
The Critical Care Outreach Team at the Royal was one of the first in the country and consists of a small team of Nurse Clinicians, who are Masters Graduates and qualified in Non-Medical Prescribing.
They deliver a seven-day service, assessing, reviewing and managing the deteriorating patients both on the Royal site and at the Clatterbridge Cancer Centre.
In 2021 the CCOT nurses saw 556 acute referrals and conducted 926 visits for these patients; 789 patients were referred for post Critical Care Follow Up, requiring a total of 840 visits.
Along with our consultant colleagues they help to deliver outpatient follow up clinics and they teach course both in-house and at the University including post-graduate Critical Care nursing, ALS/ILS, Tracheostomy and Sepsis study days.
Specialist Pharmacists - Ms Patricia Crossey, Ms Jennifer Hughes
Medicine is the most common intervention in healthcare, and we have two specialised pharmacists across the Critical Care areas that provide pharmaceutical advice to ensure that all medicines prescribed are safe, evidence based, appropriate and compliant with local and national guidelines. We are a key part of the daily consultant led ward rounds and advise on dosing, interactions, side effects and monitoring of medicines.
Specialist Dietitian - Ms Deirdre Long
The role of the dietitian is to assess the nutritional requirements of patients and develop, implement, and monitor nutrition strategies and interventions to meet the complex needs of critically ill patients.
Lead Physiotherapist - Ms Sarah Dyson
A team of 6 Physiotherapists and 2 Physiotherapy Assistants
Physiotherapy is an important intervention that prevents and helps to reduce the adverse effects of prolonged bed rest and mechanical ventilation during a critical illness.
Rehabilitation delivered by the physiotherapists and the rest of the multidisciplinary team is tailored to the patients’ needs and depends on their conscious state, psychological status and physical strength. It incorporates any active and passive therapy that promotes movement and includes bed-based exercises, sitting out in a chair and mobilisation. Early progressive physiotherapy, with a focus on mobility and walking, is essential in minimising functional decline.
Physiotherapy also helps to wean patients from mechanical ventilation by clearing secretions from their lungs and improving their overall strength to allow them to breathe unassisted.
Speech & Language Therapist – Ms Charlotte Mistry
Ms Mistry leads a team of 3 Therapists and one assistant Therapist.
Speech and Language Therapists work with people who have difficulties with swallowing and communication, a common problem for the critically ill.
Speech and Language Therapists assess swallowing using different types of food and drink. They may also use a camera test (called a FEES) or an x-ray (called a videofluoroscopy) to help guide their management. They may suggest specific swallowing exercises or techniques to help and work with other members of the team to promote independence with eating and drinking.
Speech and Language Therapists can support a person’s communication and interaction when they are critically ill. Some of the medication used for sedation, the presence of a breathing tube in the mouth or neck or being very tired or disorientated can all affect communication. Speech and Language Therapists may provide communication charts or suggest specific techniques, exercises or strategies to help.
We tailor care specifically around the individual patient. We use a form called ‘This Is Me’ to understand more about the person, what they like to be called, their likes/dislikes and how they prefer to be communicated with.
Occupational Therapist - Mrs Sally Westhead
Ms Westhead leads a team of 3 Occupational Therapists and one therapy assistant.
Occupational Therapists help patients adjust to and overcome the physical and psychological effects of being critically unwell by supporting individuals to take part in and carryout everyday activities. Their role includes:
Principal Clinical Psychologist - Dr Ellie Pontin
Located across both the Royal and Aintree sites, Dr Pontin works as part of the multi-disciplinary team to promote psychological aspects of patient care in the critical care setting, and in the rehabilitation and recovery following critical illness. She works directly with patients and their families during their time in Critical Care, right through to hospital discharge and outpatient follow up to support them with the psychological impact of a Critical Care admission. In addition, she also offers group and individual support for all Critical Care staff.
On ITU, each patient has their own nurse looking after them. On HDU this is 1 nurse looking after 2 patients. To improve quality of patient care and job satisfaction for the nurse, we aim, where possible, for the same group of nurses to care for your relative. The nurses will try to form close relationships with you, thus enabling us to all work together and keep the lines of communication open.
Your relative will be attached to monitoring equipment. They may require assistance with their breathing and could be attached to a ventilator (breathing machine).
Often, they will have tubes and drips and there will be fluid pumps around the bedspace. Please do not be frightened by the equipment or noises, the nurses are trained to look after all the equipment and will answer any queries.
Although your relative may look different and may be sedated with medication to tolerate the machinery, do remember they still need to hear familiar voices and need to be touched. So, let your relative know you are there by talking to them and hold their hands if you'd like to. Although we realise this may be difficult at first, we will do everything to help you.
All our nursing staff wear uniforms according to their grade and a lanyard to highlight their role with their ID.
Whilst we will do our best to stick to the visiting times, there may be times when your relative is undergoing a procedure or is having their hygiene needs attended to. Therefore, we may ask you to wait in the relatives' room until we allow you on the unit. The nurse looking after your relative will keep you informed on how long you may be asked to wait.
We will do our best to keep you informed of your relative's progress, and will ask you to provide a password, so we can offer information via phone calls too. We also have an option to video call your relatives if, for any reason, you are unable to visit. Please ask your relative's nurse for any further information.
We understand having a relative in Critical Care can be a very anxious time, and we are here to support you too. Please do not hesitate to discuss any concerns with the nursing staff, nurse coordinators or Matron.
Intensive Care is situated on the first floor on the 'XYZ' side of the hospital; from the main entrance head to the left side of the hall and take the lift or stairs to the first floor.
HDU is situated on the 8th floor of the 'ABC' side of the hospital; from the main entrance head to the right side of the hall and take the lift to the 8th floor.
POCCU is on the 11th floor in the Theatres area and can be accessed using the XYZ lifts.
The Critical Care Unit supports organ and tissue donation and has specialist staff who support decision making when this is a possibility. Further information on organ donation can be found on the NHS Blood and Transplant website.
The Critical Care Clinical Psychology follow up clinic provides evidence based psychological interventions to help you make sense of your experiences as a critically ill patient, and to address any on-going problems you are having with your mental health since being discharged from hospital that are due to your admission to critical care. This may be a one-off appointment with the Critical Care Clinical Psychologist, or a few sessions on a regular basis. The Clinical Psychologist will be able to provide you with resources that can help you and your family, and also help you access any further psychological or mental health services if you need them.
If you would like to make a charitable donation, please contact the Fund-Raising Department on 0151-706-3153 and specify 'for critical care' in a cover letter.
We have been fortunate to receive donations including TVs and radios for patients.
QI/Clinical Audit Lead (Royal site)– Dr Chian Chyn Leo Khoo
Quality Improvement (QI) in health care is defined as:
“The combined and unceasing efforts of everyone to make the changes that
will lead to better patient outcomes (health), better system performance
(care) and better professional development (learning)"
Batalden PB, Davidoff F. What is ‘‘quality improvement’’ and how can it transform healthcare? Qual Saf Health Care 2007; 16: 2–3
We are the exceptional Critical Care Unit that embrace the culture of change and constantly look for opportunity for continuous improvement in patient care. We constantly encourage, support our invaluable staff to think innovatively and to empower them to carry out QI projects. We believe our strong engagement with QI is the way to enhance patients experience and outcomes as well as staff wellbeing.
We are committed to support staff and junior doctors in Quality Improvement projects, providing them with the right tools and training.
Opportunity for junior doctors and health care allied professionals
For further enquiry, please kindly contact the QI/Clinical Audit Lead of the unit Dr Chian Chyn Leo Khoo (firstname.lastname@example.org).
Non-urgent enquiries via:
Critical Care Research explores treatment and diagnostic options to decrease complications and improve outcomes for people who are critically ill. Common conditions associated with critical illnesses include sepsis, renal failure, acute respiratory failure and shock. Prevention, diagnosis and treatment of organ failure and long-term consequences of critical illness is the main focus of critical care studies. Research nurses, intensive care consultants and trainees, research fellows, Allied Health Professionals and associate PIs form our multi-disciplinary workforce form an active research team. Much of our research work is done in collaboration with the University of Liverpool, Liverpool John Moores University and the Liverpool School of Tropical Medicine. Our core team members include
Follow us on Twitter: @LivCritCare
Information for patients
Our ICU actively supports clinical research to improve patient care. We conduct a variety of studies which involve collection of data only (observational studies) or testing of novel devices, treatments or medication (interventional studies). Our work is supported by and closely linked to the National Institute for Health Research (NIHR, https://www.nihr.ac.uk).
We have a portfolio of research studies that are active and recruiting, ranging from data collection only to more complex interventions and novel therapies. We may speak to you about the possibility of participation of yourself or your relative into a research study. Details of the study will be fully discussed with you. You will then be given time to think about whether you or your relative would want to take part in the study. The decision you make will in no way affect the care you or your relative receive. All studies performed on our unit have been reviewed and approved by the relevant authorities. If you would like to learn more about clinical research, please watch this video that has been produced in collaboration with our ICU here: https://www.youtube.com/watch?v=6HOTEIv46ec.
Information for medical professionals and students
Our multi-disciplinary research team is led by Professor Ingeborg Welters. In collaboration with the University of Liverpool we regularly supervise research projects for graduate and undergraduate students. As part of intercalating programmes, we facilitate projects for Research Masters students and final year medical students. We also offer funded and unfunded PhD projects for biomedical graduates. Our research group conducts NIHR and commercial studies and enjoys cross-specialty collaborations spanning a wide range of topics and activities, including first-in-human studies, experimental medicine and data science. Our research interests include cardiovascular changes during critical illness, rehabilitation and the cross-talk between immune and clotting systems during infection. We closely work with the Liverpool Centre for Cardiovascular Science and the Institute of Life Course and Medical Sciences at the University of Liverpool.
If you are interested in working with us on a research project as a student, researcher or medical trainee, please contact us at ITUresearch@rlbuht.nhs.uk.
Studies currently open at the Royal Liverpool Hospital
* Royal Liverpool ICU is the lead centre for this study.