History of the Nepean ICU
Nepean Hospital in the early 1970s was a very different place to the busy hospital of the new century. Penrith itself was still a semi-rural area. No critical care facilities existed at all in the hospital with the exception of the Casualty Department and the Operating Suite. However the need for a specialty area for the care of critically ill patients had been felt and plans were made to build a 7 bed Special Care Unit adjacent to the existing Casualty Department.
This was at a time of some expansion of the population in the Penrith area and some pressure on the existing 179 beds. It was noted at the time that the total number of inpatients treated (for the financial year 1971-1972) was 11,060 while Outpatient and Casualty attendances were a combined 56,671. These figures represented a significant increase on previous years.
The Special Care Unit: 1970s
And so the decision was made to build a 7 bed Special Care Unit, and work was completed in 1971. It was a very small Unit with the beds spread out in a fan-shaped fashion with small, high windows and a carpeted floor.
The Unit did not have its own director but was run instead by the current Director of Anaesthesia Dr T.V. Rice (pictured at the left). The equipment behind Dr Rice is a state of the art resuscitation trolley at the time including a defibrillation unit that may be familiar to older Critical Care nurses and doctors. It is interesting to note that the total sum of $24,475.50 was required to outfit the SCU with such equipment. As for the nurses uniforms, times have certainly changed!
The Annual Report of the Nepean District Hospital in 1972 gives a great deal of space to the opening of the Special Care Unit. Part of the Chairman's Report is quoted in full below to illustrate the ideas behind the creation of the SCU.
'The Special Care Unit has undoubtedly been the greatest step forward in patient care facilities since the addition of the Maternity Unit in 1965. This Unit has enabled the hospital to accommodate the most seriously ill patients in an area where highly skilled and experienced nursing staff are available, and where life-saving and continuous monitoring equipment is concentrated. By this means patients are placed under the closest possible observation, and any change in their condition is immediately noted, and if necessary, remedial action can be taken by the specially trained staff, with the most modern equipment readily available. Under the control of the hospital's Director of Anaesthesia, Dr T.V. Rice, the Unit, since its opening, has treated patients suffering from a wide range of serious illness and injury. These include acute medical and heart conditions, traffic accident victims, overdose patients, post-operative care and patients suffering from electrolyte imbalance. Each of the seven beds of the Special Care Unit is equipped to monitor patients' blood pressure, respiration, temperature and pulse rate. Information on each of these parameters is fed to monitors at the Unit's central station, and an electrocardiograph can be taken at any time. Should a patient's condition deteriorate, an alarm is triggered alerting the staff to the patient's need. Special beds have been installed so that the patients can be positioned according to the treatment necessary for the illness or injury, and a "Crash Trolley" complete with the latest resuscitation equipment has been provided. Piped oxygen, suction and air is available at each bed. The Unit is air conditioned to ensure that patients are accommodated under the most favourable conditions for their recovery. This advancement of patient care facilities was made possible by the generosity of the citizens of Penrith and district, and with the valued assistance of the Hospitals' Commission.'
It is interesting to note the emphasis in this report on "highly skilled and experienced nursing staff" and also to note that the Unit's Director was actually the Director of Anaesthesia. In the early 1970s of course Intensive Care was still emerging as a specialty and in Australia the key event, the formation of the Australian and New Zealand Intensive Care Society (ANZICS), did not actually occur until 1975.
Pictured at the left are Miss W. Case (Hospital Matron), Mr R. Rylance (Hospital Superintendent) and RN Sampson in the Special Care Unit early in the 70s. Uniforms have changed more than a little since this time as has the deferential attitude of nurses.The existing SCU served the hospital well until July 1983, a total of just over 10 years. By then the era of the Bird Ventilator was ending and Intensive Care was an emerging specialty. There was need for more space and newer equipment and the SCU was moved from near the Casualty Department to a newly designed and built area in the North Block of the new hospital.
Intensive Care in the North Block: 1980s
A pivotal moment in the development of the Nepean Intensive Care Unit came in April 1983 with the opening of the new Intensive Care Unit in the North Block of the Hospital. The current Nurse Unit Manager of the ICU Veronica McCartan was also in charge at that time and guided the transfer to the new premises. There were 10 available beds in the new Intensive Care Unit while the Coronary Care Unit, which was joined to this Unit by a short corridor had 5 available beds. The opening of these twin units marked the beginning of Nepean Intensive Care as a major ICU in the Sydney area. Pictured here is the Intensive Care Unit shortly before it was opened for patients in 1983.)
In 1986 Dr Anthony McLean was appointed as Director of the Intensive Care Unit. The Inaugural Annual Report of the Nepean Hospital in 1986/1987 describes the appointment as follows:
'The Intensive Care Unit became fully operational in early 1986 with the appointment of Dr Anthony McLean as Director of Intensive Care. The presence of an Intensivist on site and particularly one of the calibre of Dr McLean has closed what was perceived as the most glaring gap in our Medical Services. Not only can we now offer an extended range of services to the local community, in particular more complicated surgical procedures, but many patients previously transferred (with difficulty) to Teaching Hospitals may now be managed close to home and relatives. This change has had a most beneficial side effect for the morale and identity of the hospital and 'put us on the map' as a subregional referral hospital'
At this time as well the workload of the Intensive Care Unit picked up substantially as new positions for Staff Specialist and Visiting Medical Officer in the following areas were advertised and filled: Vascular Surgery, Thoracic Surgery, Respiratory Medicine, Renal Medicine, Anaesthetics, ENT, Endocrinology, Pathology, Obstetrics and Gynaecology and Neurology.Many of these specialty areas needed High Dependency or Intensive Care beds for their patients.
Teaching Hospital Status:1989
A pivotal moment for the Nepean Intensive Care Unit was the approval on 27th November 1989 for the establishment of the Nepean Hospital as a Teaching Hospital of the University of Sydney. The existing Minister of Health Peter Collins called for the upgrading of the existing Nepean Hospital to a fully functional Teaching Hospital by December 1994.
Of vital importance to the Intensive Care Unit was the creation of a an academic position for Critical Care: a chair in Critical Care Medicine. In 1991-92 Dr Anthony McLean, the Director of the Intensive Care Unit was appointed as senior lecturer in Critical Care and later as Associate Professor. Plans at this time were also made for building works to create the physical essentials for a teaching hospital including extensions to the Intensive Care facilities.
The High Dependency Unit: 1994
1994 to 1995 was a major year for the Nepean Hospital as a new 5 storey clinical services building was constructed to house a new Emergency Department, Outpatients Department, Medical Imaging, Surgical and Medical Wards, Physiotherapy and Occupational Therapy Departments and a new Coronary Care Unit. The existing Coronary Care Unit (pictured at the left) was transferred to its new premises in the West Block in October 1994 and the responsibility for this department was handed over to the Medical Division. A 5 bed High Dependency Unit was created in its place and rapidly became a very busy unit with its beds in high demand. The great need for these High Dependency Unit beds continues to this day.
Developments After 2000
The existing Intensive Care and High Dependency Units served the Nepean Hospital well but plans were in place towards the end of the century to build a new 12 bed Intensive Care Unit and to refurbish the existing Intensive Care Unit as a High Dependency Unit. This change, which has been fully implemented, is currently being researched.
In May 2010, construction will start on a new 12 bed pod for the ICU. This will increase the current bedspaces from 20-24. In addition to this, new state of the art support, office and meeting facilities will be built. A new cardiovascular ultrasound unit will also be built as part of this project. The work is expected to be completed by September 2011.