Life in the Alfred ICU
Most people who pass by The Alfred’s ICU building are unaware of what happens inside – but anyone who has entered its doors as a staff member, a patient or a loved one, will have a compelling story to tell.
With a total workforce of around 800 staff that care for around 3800 patients a year, The Alfred ICU is one of the country’s busiest intensive care units – and where some of Australia’s most critically ill patients are taken for treatment.
Clinical Services Director Tania Birthisel said despite the gravity of the work that happens in the ICU, the general feeling on the floor is calm and collected.
“It can be a real shock to find yourself in the ICU, whether as a patient or a visitor,” Tania said.
“What visitors might not expect is the amount of expertise we have on hand, the level of care they bring, and the lengths that our unit goes to ensure people are cared for.”
Mona Schwalger, 31, was one of those people, rushed to The Alfred after a traumatic workplace accident left him with a shattered chest and sternum, a punctured lung and broken ribs.
It was the first time his wife Alanna, 30, had been to an ICU and it’s an experience she says she will never forget.
“One of the doctors, he said to Mona’s brother and I, ‘I’m going to tell you straight out how it is’,” Alanna said.
“‘It’s as if he’s walking along a cliff’s edge, he can fall either side at any moment, but we will do everything that we can to make sure he stays on track’.”
On a typical day, around 90 nurses and 25 doctors gather in the tearoom in the early hours of the morning.
There they receive a briefing from Nurse Unit Manager Annabelle Maclure, who lets them know how many patients were admitted overnight along with other critical information that will inform the day ahead.
After the morning huddle wraps up, staff disperse across The Alfred ICU’s three floors and the ward rounds begin.
A team of doctors, nurses and a pharmacist make their way from bed to bed, stopping at each patient to observe and note their current condition, review their treatment, and assess whether additional Alfred specialists should be engaged.
Intensivist Dr Brooke Riley, who leads one of the teams, said if a patient’s condition falls under one specialty, they will likely be seen by 30 clinicians in one day. If they have multiple injuries requiring different specialties, the number quickly grows.
Alanna said she started keeping a list of everyone involved in Mona’s care and couldn't believe how quickly the list grew to over 50 people.
Acting Director of Alfred ICU Dr Maurice Le Guen said families and friends are encouraged to ask any and all questions related to their loved one’s care.
“We’ve found that many families are assured by having more information, so we will always do our best to keep them up to date and respond to every question they have,” Dr Le Guen said.
“It’s a very stressful time, so it's not unusual that they may ask the same one more than once, and we completely understand that.”
"On the day that Mona came in, one of the nurses said you can put up a photo wall and it was a great way to take my mind off things,” Alanna said.
“I went home and printed out so many photos."
“And because we've got lots of friends and family from interstate or overseas, I had them write messages which we put up as well.”
Patients at The Alfred ICU, including Mona, receive one-on-one care from a nurse 24 hours a day. Efforts are made to roster on the same nurses with the same patient to ensure continuity in their care.
Clinical Nurse Specialist Penny Howard said spending long amounts of time with a patient allows her to pick up on subtle but important changes which she can then feed back to the patient’s medical team and family.
“I can say ‘I know you’re standing here right now and he or she looks really fine, but they weren’t ten minutes ago; and everybody is happy to listen,” Penny said.
Alfred ICU Nurse Unit Manager Annabelle Maclure said the level of care shown by all staff at the ICU amazes her every single day.
“And it’s not just doctors and nurses; it’s also pharmacists, physios, social workers, psychologists and support staff,” Annabelle said.
“There’s so many things that each of these specialists do that add into everything else that the doctors and nurses are doing.”
Upstairs, Elizabeth Bakker, a Burns Clinical Nurse Consultant – a unique specialisation and the only person to hold the role at The Alfred – works with a team of four nurses to treat a patient with severe burns.
Other hospitals require a surgical theatre to change a burns patient’s dressings, but thanks to the team’s specialised skills, they’re able to carry out the task in a hospital room.
In the end, Mona stayed at the Alfred ICU for 14 days. He’s now back at home and continuing with rehabilitation.
“I’m just so grateful to them for keeping me alive,” Mona said.
“We’d only been married one year and I could have been gone.”
Alanna agreed.
“The ICU staff were an amazing support, not just looking after Mona but looking after our family and friends,” Alanna said.
“They really took the time to get to know Mona, to get to know all of us.”
This year marked 60 years of The Alfred ICU, home to a range of statewide services including heart & lung transplantation, mechanical circulatory support, extra-corporeal membrane oxygenation (ECMO), burns and hyperbaric medicine. It also provides Victoria's Adult Cystic Fibrosis and Pulmonary Hypertension services.
