Pathway of care for trauma patients
Each patient’s hospital stay is slightly different because no two patients’ injuries are the same. The doctors, nurses and other health-care professionals in each part of the hospital have different specialized training and skills. Our goal is to make sure you get the right care for the different parts of your recovery.
In this part of the guide, we explain the different areas of the hospital, and the types of patients who might need care in these areas.
It may be uncomfortable or scary when you, or your loved one, move from one care area to another. We hope that it helps you to know that all the necessary medical information about the patient is transferred from one area to another, and that staff from different areas work closely together to make the move between units happen smoothly.
Trauma care timeline
A timeline of care for trauma patients, from arrival to discharge. Including important phone numbers, and unit locations.
You may move back and forth between units, depending on your medical needs. Surgery may take place at anytime during your hospital stay.
| Arrival: The Emergency Department | Critical Care Unit (CrCu) | B5 Intensive Care Unit (ICU) | C5 | Discharge (Leaving the hospital) |
|---|---|---|---|---|
|
Patients are assessed in the trauma bay. This assessment will help determine the best place in the hospital to care for their injuries. Location: B-Wing, Ground Floor (BG) |
Patients in the most critical condition are admitted to the Critical Care Unit (CrCU). They may need life support. Location: M-Wing, 2nd Floor (M2) Phone: 416-480-4196 |
Patients with serious injuries that require continuous monitoring go to the B5 Intensive Care Unit (B5 ICU). Location: B-Wing, 5th Floor (B5) Phone: 416-480-4189 |
Patients no longer require intensive care, but still need the attention of the trauma team. Location: C-Wing, 5th Floor (C5) Phone: 416-480-4187 |
Patients may be sent to one of the following places when they no longer need the specialized care of Sunnybrook’s trauma team:
|
The staff doctor who oversees your care is called the Most Responsible Physician or MRP. Your MRP may change, depending on where you are in the hospital and staff schedules. Ask your nurse: "Who is my MRP?"
About the pathways of care
1. Arrival: The Emergency Department (ED)
About the ED and the trauma bay
It is likely that an ambulance or a medical helicopter brought you or your loved one to Sunnybrook’s emergency department (ED). Once in the ED, patients are immediately assessed in the trauma bay, which is a special part of the emergency department used only for the care of trauma patients.
In the trauma bay, patients are cared for by a trauma team, which include specialists with the training and skills to provide emergency care. The whole team is led by a trauma team leader, a doctor who is an expert in trauma care. Care in the trauma bay includes blood tests, x-rays, CT scans, pain management and, for some patients, emergency life-saving procedures.
After the patient’s injuries are found, the trauma team leader works with other doctors in the hospital to decide about the best place for each patient.
The most serious and significant injuries are typically the first to be identified in the trauma bay.
Other less serious injuries may be identified over the next few days following your admission.
Why the trauma bay can seem like a frightening place
- The trauma bay can be loud and confusing because of the large number of doctors and nurses working together to quickly find and treat life-threatening injuries.
- Patients arrive with very painful injuries, and often receive strong pain medication that may make them feel confused.
- In order to find every injury as quickly as possible, the patient’s clothes are cut off with scissors, which can be upsetting.
- While the trauma team tries to explain what is happening every step of the way, many patients find the information comes so quickly that it might be hard to understand.
Talk to your medical team about your experiences in the trauma bay. We can help fill in missing pieces of information and answer your questions.
2. Surgery and the Operating Room
After an injury, some patients will require surgery, while others will not. No two patients are the same. There are many factors that your doctors will consider when deciding whether you (or your loved one) will need surgery.
Some factors for surgery include
- The type of injury being treated
- The patient’s overall health before he or she was injured and how sick the patient is right now
- The patient’s wishes about his or her care and treatment
Important things to know about surgery
- Some patients will need immediate surgery for a life-threatening problem as soon as they arrive in the trauma bay. These patients will go straight to the operating room from the emergency department. Other patients who are more stable may have surgery later in their hospital stay.
- In-patients with more than one injury, the doctors will work together to decide which injuries must be treated right away, and which should be treated later when the patient is less sick. Some patients will have many surgeries during their hospital stay.
The surgeon said the patient will be having surgery today, but can’t give a time. Why?
Each patient is added to an emergency operating room list. The order in which surgeries are done is based on:
- How urgent it is to do the operation
- The order in which patients are added to the list
The surgeons all work together to make sure the sickest patients get their surgery done first, even if they were added to the list later. For example, a patient might arrive in the emergency department after a bad car crash, and need a surgery to save his or her life right away. This means that sometimes patients who were already on the list might wait a longer time for their surgery. At times, the wait may be days.
We know the wait can be very frustrating and difficult. We appreciate your patience – you are helping other patients in the hospital get the care they need, when they need it.
Location of Operating Room waiting areas for family members
- The operating room waiting area is in A-Wing, 1st Floor, Room 48 (A1 48). [Please note that after hours, families wait in the M-Wing, 2nd Floor (M2) waiting area.]
- If you are a loved one of a patient, it is important to tell the surgeon, or nurse, where you will be after surgery so you can be updated on the patient’s condition. If you carry a cellphone, give the number to the surgeon or nurse.
- If the patient will be admitted to the Critical Care Unit (CrCU), you can wait in the M2 waiting area. (Take the main elevators in M-Wing to the 2nd Floor.)
Visiting the patient after surgery
- Many patients go to the Post Anesthetic Care Unit (PACU) after surgery. The PACU is located on M2 (M-Wing, 2nd Floor).
- Speak to a volunteer in the M2 waiting room area about visiting a patient. If a volunteer is not on duty, follow the instructions on the phone located in the visiting area. Some patients go directly from the operating room to the Critical Care Unit (CrCU) after surgery.
- If the patient goes to the CrCU, you can call into the CrCU 45 to 60 minutes after surgery to check whether he or she is ready for visitors. (See Intensive Care Unit section below)
3. Intensive Care Unit
Intensive-Care Units (ICUs) are designed for the care of patients with the most severe injuries. Some patients are well enough to not need ICU admission, and go directly to a specialized trauma ward. Note: you can find more information about Sunnybrook's ICU at sunnybrook.ca/navigatingtheICU
Care in an ICU includes
- Special monitors that check oxygen, heart rate and blood pressure
- Machines that can provide life support
- Special medications needed by the sickest patients
Care in the ICU is a team effort. Doctors, nurses and other health-care professionals who are experts in life support work in the ICU. The staff intensivist is the head doctor in the ICU, and coordinates the recommendations of the many members of the care team.
ICU team members work with other doctors who are experts in treating the injuries of trauma patients, including:
- Trauma surgeons
- Orthopedic surgeons
- Neurosurgeons
- Plastic surgeons
- Other surgical experts if needed
Patients’ families are also an important part of this team. If you wish to speak to any of the specialists while your loved one is in the ICU, please let the ICU team know.
The patient is permitted to have up to two family members present during daily rounds, when the health-care team gets together to discuss each patient individually at the bedside. We do ask that you hold any questions until after rounds.
At Sunnybrook, there are 2 types of ICUs
1. Critical-Care Unit (CrCU) – M-Wing, 2nd Floor
Patients in the most critical condition are admitted to the CrCU. These patients might need specialized forms of monitoring and life support, including mechanical ventilation (breathing machine).
2. Neurotrauma ICU (B5 ICU) – B-Wing, 5th Floor
- Patients with serious injuries who require constant checking of their injuries or their medical needs, but who do not need the specialized monitoring or life support of the CrCU are admitted to the B5 ICU.
- Some patients may be transferred to B5 ICU from CrCU after their condition improves significantly.
- Other patients are admitted to B5 ICU directly from the emergency department.
Visiting hours and rules for the ICU
- You must call into the ICU before visiting. There is a phone at each ICU entrance, which you can use to ask for the door to be opened.
- Visitors are allowed 24 hours a day in the ICU. However, there are some times when visitors are not allowed. From 7:30 a.m. to 8:15 a.m. and 7:30 p.m. to 8:15 p.m., there is a change over in the nursing teams and visitors are not allowed in order to protect patient privacy.
- Only two visitors are allowed at a time.
- You may be asked to leave your loved one’s bedside during tests, certain types of nursing care, bathing and at other times. Please be respectful of these requests – they are in place for your loved one’s safety and privacy.
Location of ICU waiting rooms
- CrCU – the waiting room is on M-Wing, 2nd Floor. Take the main elevators to the 2nd Floor.
- B5 ICU – the waiting room is on B-Wing, 5th Floor. Take the main elevators to the 5th Floor, and follow the signs to the B area of the hospital.
Phone numbers for the ICU
- CrCU: 416-480-4196
- B5 ICU: 416-480-4189
Should I spend the night in the hospital while my loved one is in the ICU?
We understand that there will be times when you want to spend the night in the hospital with your loved one, particularly if the doctors let you know that your loved one is very sick. You are allowed to spend the night in the waiting room, or in a chair at your loved one’s bedside. However, we strongly encourage you to use nighttime to rest at home.
- Recovery from injury is a long process, and we know from past experience that families get exhausted very quickly.
- Sleep is an important part of keeping up your strength, which will be needed to help and encourage your loved one during his or her recovery.
- We encourage you to leave a phone number with the bedside nurse in the ICU. If anything were to change with your loved one’s condition, we will call you.
Your feedback is welcome
