There are six sites with ICUs for adults across Island Health, located in Victoria (Victoria General Hospital and Royal Jubilee Hospital), Nanaimo, Duncan, the Comox Valley, and Campbell River.
The Critical Care program offers specialized care for adults facing serious, life‑threatening illnesses or injuries. This includes care in an ICU which is different from regular hospital care because patients need constant monitoring and specialized equipment.
Island Health’s ICUs provide specialized care for adults who are critically ill or injured. Patients in the ICU need close monitoring and support for vital organs such as the heart, lungs, kidneys, or brain. The ICU uses advanced equipment and continuous observation to help patients through serious illness.
Island Health offers two levels of ICU care:
At Royal Jubilee Hospital, specialized critical care also includes the Cardiovascular Unit (CVU) and Cardiac Care Unit (CCU), which provide focused care for patients recovering from cardiac surgery, heart attacks, and other serious heart and vascular conditions.
Care in the ICU is provided by a team that may include physicians, nurses, respiratory therapists, pharmacists, dietitians, and rehabilitation staff. These teams work together to support breathing, heart function, medications, nutrition, and recovery needs.
Across all sites, families are kept informed, interpreter services are available, and hospitals offer accessibility supports to ensure safe and comfortable access to care. Patients are admitted based on medical urgency, often through the emergency department, hospital wards, or after major surgery.
Note that ICU care is provided whether or not you have coverage. If you do not have MSP or another Canadian health plan, you may be billed directly, and private insurance can help cover costs.
ICU services are delivered in person.
When to visit the ICU
Mornings are busy times in the unit for patient assessments, care, and diagnostic tests. There may be delays visiting your loved one. Please avoid planning to visit between 7 a.m. to 9 a.m. and 7 p.m. to 9 p.m. as these are shift change periods for bedside staff.
Safety for when you visit
All visitors must wash their hands before visiting and wear the indicated personal protective equipment (PPE) as outlined on the room door. The ICU is a scent-free zone. Please refrain from wearing scented products and perfumes/cologne.
Respectful and safe visiting practices
Visiting with children
Family space
Families and significant others are important members of the ICU team. We are committed to keeping you informed about the patient’s condition and treatment plan, and there are several ways to stay connected with the ICU team. Communication can take place in person, by telephone, or through video conferencing. Please let us know which method works best for you.
Daily Rounds
Daily rounds occur every morning and/or afternoon, and you are welcome to join these interdisciplinary discussions. Rounds provide an opportunity to hear directly from the team about the patient’s progress and the plan for care. Start times may vary depending on activity in the unit, and staff will let you know when rounds are expected to begin.
Contacting the Unit
You may call the ICU nursing desk at any time to request an update. The bedside nurse caring for the patient will speak with you whenever possible. If the nurse is unable to come to the phone immediately, we will return your call as soon as we are able. Your patience is appreciated, especially during busy periods.
Family Conferences
If you would like a more in‑depth conversation about the patient’s condition or to ensure that medical decisions align with the patient’s wishes, you may request a family conference. These meetings can be arranged at your request, or the care team may contact you directly if they feel a formal discussion would be helpful. Family conferences provide an opportunity to ask questions, clarify medical terms, discuss the risks and benefits of tests or treatments, review medications, and receive support in communicating with the patient.
During High‑Demand Periods
During times of increased patient volumes, updates may occasionally be delayed. Caring for all patients remains our primary responsibility, and we appreciate your understanding if communication takes longer than usual. The ICU team will do their best to work around your schedule and keep you informed.
Your role as part of the care team
Families and significant others play an important role in supporting a patient’s recovery. Your presence, voice, and reassurance can provide comfort, even when the patient appears sleepy, confused, or unable to respond. The ICU team will guide you on what is safe and helpful at each stage of care so you can participate with confidence.
Communicating with the patient
Even if the patient cannot speak or respond, hearing familiar voices can be calming. Simple messages such as “You’re safe” or “I’m here with you” can help reduce anxiety and create a sense of connection. Speaking slowly and gently can be especially reassuring.
Providing comfort and orientation
Patients in the ICU may feel disoriented or unsure of where they are. Gently reminding them of the date, time, and place can help them stay grounded. If allowed, familiar items—such as a favourite photo or piece of music—may also provide comfort and support emotional wellbeing.
Knowing what is safe to do
The care team will let you know what is appropriate at the bedside. This may include when it is safe to touch the patient, how to avoid interfering with medical equipment, and how you can support care routines without disrupting treatments. Staff are always available to guide you and answer questions.
The family spokesperson
The family spokesperson is the main point of contact for the ICU team. Having one designated person helps reduce repeated calls and ensures information is shared accurately and consistently. The spokesperson keeps everyone informed by communicating updates in an organized way, and writing down key points or questions can help during conversations with staff. They also gather questions from family members and bring them forward during updates, helping the care team address concerns efficiently and ensuring the family’s perspective is included in care discussions.
Taking care of yourself
Supporting someone in the ICU can be emotionally and physically demanding. It is important to look after your own wellbeing so you can stay grounded, make decisions clearly, and be present when needed. The ICU team encourages you to take breaks, rest, and reach out for support when you need it.
Taking Breaks
Spending long hours in the ICU can be exhausting. Stepping outside for fresh air, having a meal, or taking a short walk can help you recharge. Breaks allow you to return to the unit with more clarity and energy. Staff will contact you if there are important changes, so it is okay to step away.
Managing Stress
It is normal to experience stress, worry, or uncertainty during an ICU stay. Speaking with friends, family, or support services can help you process what you are feeling. Some people find it helpful to write down thoughts or questions, practice deep breathing, or take a few quiet moments to regroup.
Staying Connected with Support
Your personal support network can be an important source of strength. Staying in touch with people who care about you, whether through a phone call, text, or visit—can help you feel less isolated.
The ICU team work together to monitor the patient, provide treatments, and support recovery. Each team member brings specialized skills, and staff collaborate closely to ensure safe, coordinated, and effective care. Team members are available to answer questions and explain their role at any time. Below is a brief description of each role.
Critical Care Registered Nurses
ICU nurses have advanced training in caring for critically ill patients. They spend the most one‑on‑one time at the bedside, performing detailed assessments, closely monitoring vital signs, administering medications and treatments, and responding quickly to changes in condition. They work closely with physicians and the rest of the care team while providing both hands‑on care and emotional support.
Physicians
Physicians assess the patient’s condition, interpret test results, and make decisions about complex treatments. They prescribe and adjust medications, oversee the use of advanced equipment, and coordinate the overall plan of care. Physicians work closely with the entire team to ensure high‑quality, evidence‑based treatment.
Unit Clerks
The unit clerks answer incoming calls, greets visitors, and direct families and/or significant others to the patient. Unit clerks also make sure you are connected with the appropriate nurse for timely updates and support.
Indigenous Liaison Nurses
Indigenous Liaison Nurses support patients and families by advocating for their needs, helping them understand medical information, and guiding them through their healing journey. They assist with questions, coordinate smooth transitions between home, hospital, and community, and connect people with cultural, spiritual, and traditional healing supports.
Respiratory Therapists
Respiratory therapists (RTs) are experts in breathing and lung health. They manage ventilators and other respiratory equipment, deliver treatments, perform diagnostic tests, and monitor breathing closely. RTs play a key role in supporting patients who require assistance with ventilation or oxygen therapy.
Pharmacists
Pharmacists ensure that medications are safe, effective, and tailored to the patient’s needs. They review all medication orders, monitor for interactions, and adjust treatments based on the patient’s condition. Pharmacists participate in daily rounds and provide guidance on drug selection, dosing, and administration.
Physiotherapists
Physiotherapists help patients maintain or regain mobility, strength, and lung function during critical illness. They assess movement abilities, create individualized mobility plans, and assist with activities such as sitting, standing, or walking when safe. They also use techniques to improve breathing and prevent complications like muscle weakness or stiffness from prolonged bed rest.
Occupational Therapists
Occupational therapists support patients in maintaining or rebuilding everyday functional abilities. Their work includes early mobilization, cognitive stimulation, positioning, and strategies to reduce delirium and prevent loss of independence. They also help plan for discharge and ensure a safe transition to the next stage of care.
Speech Language Pathologist (SLP)
SLPs provides specialized support for patients who are experiencing new difficulties with speech, changes in language abilities, swallowing challenges, or other communication concerns. Through assessment and targeted therapy, SLPs help patients regain skills and adapt to changes.
Social Workers
Social workers assist with emotional coping, financial and community resources, and navigating complex care decisions. Families can request to speak with the social worker through any member of the ICU team.
Dietitians
Critical illness can change a patient’s nutritional needs. Dietitians assess these needs and develop individualized nutrition plans to support healing and recovery.
Housekeeping
Housekeeping staff are essential in maintaining a clean and safe environment. They help prevent the spread of infection by thoroughly cleaning patient rooms, hallways, and common areas, including deep cleaning rooms between admissions.
Students
You may encounter students from various health disciplines, such as medicine, nursing, and respiratory therapy. All students work under the supervision of experienced staff who oversee their learning and ensure that care remains safe and high‑quality.
The patient may be unable to communicate their needs or wishes during their ICU stay. When this happens, a temporary substitute decision maker may be needed to make legal and health‑care decisions on the patient’s behalf. This person may or may not be the same individual acting as the family spokesperson. The health‑care team will keep both individuals—along with any other representative the family identifies—fully informed about the patient’s condition and treatment plan.
Role of a Substitute Decision Maker
A substitute decision maker speaks on behalf of the patient when they cannot speak for themselves. Their role includes informing the health‑care team if the patient has any legally documented wishes about life support or other treatments. If no legal documents exist, the substitute decision maker shares what they know about the patient’s values, beliefs, or previously expressed wishes. When no information is available, they make decisions based on what would be in the patient’s best interests. The goal is always to ensure that care aligns as closely as possible with what the patient would want.
Identifying a Substitute Decision Maker
If the patient has signed a legal representation agreement naming a decision maker, that person will be asked to make decisions and sign consents on the patient’s behalf. If no legal document exists, the health‑care team will identify the first person who qualifies and is available, following the order set out in provincial legislation: spouse, adult child, parent, sibling, or another relative by birth or adoption.
Qualifications for a Substitute Decision Maker
To act in this role, a person must meet several criteria. They must be at least 19 years old, have been in contact with the patient within the past 12 months, and have no unresolved disputes with the patient. They must also be capable of understanding the information provided, making decisions about care, and giving, refusing, or revoking consent. Importantly, they must be willing to take on the responsibilities of the role and act in accordance with the patient’s known wishes or best interests.
If no one meets these qualifications, the Public Guardian and Trustee may be asked to authorize someone to act on the patient’s behalf.
Advance care planning helps ensure that treatment aligns with the patient’s values and wishes. The doctor will discuss the patient’s condition and treatment plan with your family, including any limitations to treatment that may need to be considered.
If the patient is not responding to life‑support treatment and is believed to have an irreversible illness, the health‑care team will meet with you to discuss whether continuing life support is appropriate. These conversations can be difficult, but they are important in helping families make informed decisions. If death or a very poor quality of life is expected, and your family chooses to withdraw or withhold further treatment, the ICU team will support you through this process and help you plan how you would like to say goodbye. The comfort and dignity of the patient remain the highest priority.
Organ and Tissue Donation
If it is determined that the patient will not survive their critical illness, BC Transplant may offer the opportunity to donate organs or tissues. Donation can save or improve the lives of others and may provide meaning for families during a time of loss. The ICU team can arrange for a Trillium coordinator to speak with you if you have questions.
Delirium is a temporary change in thinking and awareness that can occur during critical illness. It may appear as confusion, restlessness, difficulty focusing, or unusual sleepiness. Delirium can come and go throughout the day, and symptoms may vary in intensity. Although it can be distressing to witness, delirium is common in the ICU and is usually reversible.
What Delirium looks like
Delirium can affect how a patient thinks, behaves, and interacts with their surroundings. A patient may appear confused, agitated, or disoriented, or they may seem unusually quiet or withdrawn. They may have trouble recognizing people, following conversations, or understanding where they are. These symptoms can fluctuate, with periods of clarity followed by increased confusion.
Why Delirium happens
Delirium can be caused by many factors related to critical illness. Common contributors include infection, certain medications, lack of sleep, pain, dehydration, or the stress of being in an unfamiliar environment. The ICU setting itself, bright lights, noise, and frequent interruptions can also make it harder for the brain to stay oriented. The healthcare team monitors for signs of delirium and works to identify and address the underlying causes.
How families and significant others can help
Your presence can be grounding and reassuring. Speaking softly, offering calm reassurance, and reminding the patient of the date, time, and place can help reduce confusion. Familiar items such as a photo, a favourite piece of music, or a comforting object may also help the patient feel more oriented, if these items are permitted in the unit. Keeping communication simple and gentle can make interactions easier and less overwhelming.
What care is provided
The ICU team uses several strategies to prevent and manage delirium. This may include adjusting medications, promoting regular sleep–wake cycles, managing pain, ensuring proper hydration, and encouraging early mobility when safe. Staff may also reduce unnecessary noise and stimulation to assist with cognitive and physical recovery. Delirium is monitored closely, and the care plan is adjusted as symptoms change.
Having someone in the ICU can be stressful, and the environment may feel unfamiliar or overwhelming. Many families find it helpful to keep a daily diary of what is happening. A diary can make it easier to notice small changes over time and provides a record that can be shared later. For patients, memories of the ICU may be unclear, frightening, or completely absent, especially if delirium or sedation was involved. A diary can help fill in these gaps and offer a clearer understanding of their experience once they are feeling better.
ICU Diaries
ICU diaries help create a timeline of events that patients can review during recovery. This written record can make sense of confusing or missing memories and provide reassurance about what occurred during their illness.
Helping patients make sense of their stay
Reading the diary after leaving the ICU can help patients understand what happened, why certain treatments were needed, and how their condition changed over time. This can be especially important for those who experienced delirium or long periods of sedation.
Contributions to recovery
Families and significant others can write simple entries about visits, progress, or messages of encouragement. These contributions can be meaningful during recovery, offering comfort and helping the patient reconnect with their own story of what happened.
Leaving the ICU can happen for different reasons, and the transition can bring a mix of emotions for families and significant others. Some patients improve and no longer need intensive monitoring, while others may reach a point where recovery is not possible. In all situations, the ICU team will guide you through the next steps and ensure that care remains respectful, compassionate, and aligned with the patient’s needs and goals.
When a patient is improving
When a patient no longer requires intensive monitoring or life‑support treatments, they may move to another hospital unit. The new environment is typically quieter, with fewer machines and alarms. Care will focus on continued treatment, mobility, nutrition, and rehabilitation. The ICU team provides a detailed handover to the receiving unit to support a smooth and safe transition.
When recovery may not be possible
In some situations, despite all available treatments, a patient’s condition does not improve. When it becomes clear that survival is unlikely, the ICU team will meet with you to discuss the situation, answer questions, and support decision‑making. If the focus of care shifts toward comfort, the team will work with you to create a peaceful environment and ensure the patient’s comfort and dignity.
Organ and Tissue Donation
If it is determined that the patient will not survive their critical illness, BC Transplant may offer the opportunity to donate organs or tissues. Donation can save or improve the lives of others and may provide meaning for families during a time of loss. The ICU team can arrange for a Trillium coordinator to speak with you if you have questions.
Support during transitions
Whether a patient is recovering or nearing the end of life, transitions out of the ICU can be emotionally complex. The ICU team is available to support you. They can help with questions about next steps, provide emotional support, and connect you with community or hospital resources.
Families and significant others often find it helpful to take things one step at a time, ask for clarification when needed, and lean on their support networks. The ICU team remains committed to ensuring that care is compassionate, respectful, and centred on the patient’s needs and values.
Once a patient leaves the ICU whether to a hospital unit or community setting the focus shifts to recovery. Recovery after critical illness can take time, and it is normal for patients and families to need support during this phase.
Understanding Recovery After Critical Illness
Many patients experience physical, cognitive, or emotional changes after an ICU stay. These may include muscle weakness, fatigue, difficulty concentrating, memory gaps, sleep disturbances, or changes in mood. These effects, sometimes referred to as post‑intensive care syndrome (PICS), are common and usually improve gradually with rest, rehabilitation, and support.
Rehabilitation and Mobility
Physiotherapists and occupational therapists may continue to work with the patient after ICU discharge to support mobility, strength, breathing exercises, and daily activities. Early and ongoing rehabilitation helps prevent complications and supports long‑term recovery.
Cognitive and Emotional Healing
It is common for patients to feel confused or have limited memories of their ICU stay. Tools such as ICU diaries, counselling, and follow‑up appointments can help patients make sense of their experience. Emotional recovery may also take time, especially for those who experienced delirium or prolonged sedation.
Follow‑Up Care and Planning
Before discharge from the hospital, the care team will review medications, equipment needs and follow‑up appointments. Families are encouraged to keep a list of questions and bring it to follow‑up visits.
Community and Family Support
Recovery is often easier with support. Community resources such as home health, mental health services, caregiver supports, and rehabilitation programs may be available depending on the patient’s needs. Families and significant others may also benefit from support groups or counselling to help navigate the emotional impact of critical illness.
Taking Things One Step at a Time
Recovery after an ICU stay can be unpredictable. Some days may feel easier than others. Focusing on small improvements, celebrating progress, and asking for help when needed can make the journey more manageable. The ICU team is available to guide you and connect you with resources that support long‑term healing.
Patients are typically referred from a specialist or another department within a hospital. Patients are admitted when their condition is critical and requires intensive care.
