|Head of Department||YBrs. Dr. Melor @ Mohd Yusof bin Mohd Mansor
The Department of Anaesthesia and Intensive Care is one of the largest departments in Hospital Kuala Lumpur. We provide perioperative and intensive care services for a large number of patients mainly from Klang Valley and also throughout the country, functioning as a national referral centre.
Despite the perception that Hospital Kuala Lumpur is downsizing, the number of anaesthetics administered continues to increase annually totaling up to 24,000 cases last year. Our Intensive Care Unit(ICU) has recently inaugurated a new wing with a total of 24 beds and plans to increase to a 30-bedded ICU are underway.
As part of the national referral centre for healthcare as well as a training centre, the department has a special responsibility and is constantly planning and upgrading policies related to standards of care, training, equipment and other issues pertaining to anesthesia and intensive care for all the hospitals under the Ministry of Health.
Our mission is to provide the highest standard of anaesthetics, intensive care, pain management and related services for the community and to successfully integrate this with all the other clinical disciplines of the hospital, in a manner that is holistic, humanitarian and patient-centered with an emphasis on human dignity.
OBJECTIVES AND FUNCTION
1. To provide anesthetics, intensive care and related services of high quality and consistent with established high standards of care.
2. To increase awareness among patients and other caregivers about anaesthesia and the role anaesthetists play in their treatment and eventual recovery.
3. To actively carry out Continuing Professional Development (CPD) for the staff of the department inclusive of doctors, nurse and paramedics as we believe that CPD activities will eventually translate into high standards of patient care.
4. To promote good teamwork and excellent working relationships among all members of the department.
5. To carry out continuous quality improvement activities so that it becomes a tool for improving the standard of services and is institutionalized in the department.
6. To carry out clinical research which may include the use of new drugs that are about to be registered in the country.
The Department of Anesthesia and Intensive Care provides a wide range of anesthetic services to facilitate procedures for the multi-disciplinary surgical units at the Hospital Kuala Lumpur. There were nearly twenty four thousand anaesthetics done last year in this hospital. The current new main OT complex has been in operation since early March 2005. It consists of 12 OT's (operation theatres) fully equipped with new anaesthetic machines and computerised with the anaesthetics information management system (AIMS). Urology, neurology, paediatrics and maternity cases are being carried out in operation theatres in their respective buildings bringing a total of 14 operation theatres in these peripheral buildings.
The general ICU is located on the 3rd floor of HKL's main building. It has recently inaugurated a new wing bringing the total of 24 ventilated beds with 6 more underway.
The scope of anaesthetic services provided by our department include the following:
1. Anaesthesia for elective and emergency surgery for general surgical and subspeciality surgical services.
2. Anaesthetic Clinic for pre-operative evaluation for surgical patients.
3. Anaesthesia for MRI, CT scan, interventional and diagnostic radiology, radiotherapy, electroconvulsive therapy, dermatological laser treatment, endoscopy and other procedures in out of OT environment.
The anaesthetic clinic was set up in 2006 to provide preanaesthetic consultation and optimization of patients from all the surgical specialities in view of the increasing demand for operative medical care. It is located in the 4th floor of the main building above the main OT. Consultation is provided by a specialist anaesthetist and a medical officer on rotation with the help of 3 nurses.
On referral by the primary team, the anaesthetic clinic provides a thorough assessment of the patient, liaising with the necessary specialities for consultation and optimization of the patient at specialist level well before the planned surgery. The number of patients seen at this clinic has increased tremendously to about 3500 patients last year and we are expecting a further increase as the benefits of reducing cancellations due to poorly optimized patients become apparent.
|Monday - Thursday||7.30 am - 1.00 pm||2.00 pm - 5.00 pm|
|Friday||7.30 am - 12.15 pm||2.45 pm - 5.00 pm|
ACUTE PAIN SERVICE
The Acute Pain Service (APS) service started in July 1993. It serves to manage mainly postoperative pain in the adult patients. Now it has evolved into a more organized service where we have a Specialist Anaesthetist, a medical officer on rotation, 4 specialized APS nurses and a dedicated APS room. There is a separate APS service for the paediatric patients based in the Paediatric Institute.
ORGANISATION OF THE SERVICE
Patients are mainly selected from the daily elective operating lists and from the emergency operations. The service will be operational 24hours daily by a specialist anaesthetist and a medical officer on daily rotation with the 4 APS nurses during working hours.
Ward rounds are carried out twice a day by the APS team. Patients are reviewed and ensured that they are receiving adequate pain relief and are satisfied with the APS. The Nursing Observation Forms are also reviewed. This form contains observation on pain score, sedation score, respiratory rate and nausea and vomiting. It also contains the Standing Orders - management of complications such as nausea and vomiting and respiratory depression, as well as clear instructions as to when to call the APS doctor.
As part of our continuous audit and data collection, details about the patient, the technique used and amount of drug used, pain scores, complications and side effects are recorded. This database is used to retrieve information and the workload of the APS.
INTENSIVE CARE UNIT
The Kuala Lumpur Hospital General Intensive Care Unit is a Level 3 ICU with facilities for 30 beds. Located on the third floor of the main block of the hospital where it was formerly known as Ward 10. This ICU was opened on 26th August 1998 with a total of 16 beds. With recent expansions into the new wing adjacent to the old, an additional 14 beds will soon be fully operational.
Our Intensive care unit receives slightly above 1000 admissions a year with an average length of stay of 5 days.
2 Intensivists plus 2 intensive care subspeciality trainees, 2 specialist anesthetist and 6 medical officers perform the daily clinical work. One on-call specialist and 3 medical officers cover ICU management during after-office hours.
4 nursing sisters, 89 staff nurses, and 10 attendants staff the ICU. There are also 4 medical assistants involved in respiratory care with the unit.
The Department of Anaesthesia and Intensive Care in Hospital Kuala Lumpur is dedicated to provide comprehensive training and education for a future of excellence in anaesthetic services in the country. More details on the array of courses and tutorials we provide can be obtained from the website anaesghkl.blogspot.com.
COURSES AND CONTINUING PROFESSIONAL DEVELOPMENT
1. Post-graduate training for registrars includes tutorials and refresher courses as well as informal teaching during clinical practice. Hospital Kuala Lumpur caters for the training of the Masters in Medicine (Anaesthesiology) registrars from the University of Malaya and the National University of Malaysia. We are also an accredited training centre for the Fellowship to the Australian and New Zealand College of Anaesthetists.
2. CPD sessions for nurses, medical officers and doctors from the whole department are held from 7am to 8am every Wednesday and Thursday.
3. Post-basic nurses training in anaesthesia, intensive care, coronary care, paediatric intensive care, operating room techniques and midwifery. The department provides specific teaching modules for each of the abovementioned.
4. Anesthetic training courses for GA nurses.
5. Training in pain management for all categories of staff.
6. Cardiopulmonary resuscitation training for all categories of staff including members of the public.