HMO responsibilities: admissions & discharges, daily reviews, MET calls
Admissions / Discharge summaries:
- Currently we are completing discharge summaries on a Word document, 'DMR Pt summary template' in G:/ICU/2) ICU Admission Discharge Summaries and utilising 'Part C – Discharge Summary' for DMR when discharged
- There is a set layout, just fill in the gaps as you go
- There is a generic admission and discharge summary which you can start/update and save under the patient’s name in ‘DMR Current Admissions’ folder
- The admission summary is a pro-forma for the admission note that is copied into DMR on admission to ICU
- There is a big emphasis on handover, you may like to remind the registrar to talk to the home team when someone is being discharged. Ensure to document the name/designation of who took handover
- Try and write blood slips/ fluid orders etc. for the next day
- Please try to update the discharge summary every shift if possible, especially if discharge from ICU is probable in the next 1-2 days. This means that the person taking over from you is not rushed to do it if the patient suddenly has a bed on the ward. Rushing to write a discharge summary for a complex patient who has 100 pages of notes and you have never met before can be very frustrating so helping each other out to keep the documents updated throughout a patient’s admission is extremely helpful.
- A large portion of the workload. Every patient is reviewed thoroughly by a resident or registrar every day. This involves – talking to the patient, examining the patient, reviewing their investigation results, reviewing all their paperwork, checking plans are completed. A useful format is Issues / subjective / examination / investigations / FASTHUGS / plan
- It is often done by the night team as their ward round
- Use this time to review allied health inputs etc and to check that necessary forms are completed.
- Something that is worth paying attention to that you may not be familiar with if this is your first ICU term – MR85 forms (aka NFR forms) should be done for all patients before their discharge from ICU. Check this on your daily review and discuss with your registrar and consultant.
- Several of the long-stay patients have Patient Diaries, documents written in by medical, nursing, allied health staff as well as family. Doctors aren’t so good at writing in these, so try and make it part of your daily review.
- You can also screen patients for delirium using the CAM-ICU tool – get the registrar to show you the tool on the ICU observation chart. It’s unbelievably easy.
- Monday to Friday there is an “outreach” registrar (approx. 1100 – 2200 – changes with days) who will attend MET calls with an allocated nurse
- On the weekend there is not an outreach registrar and there is just the one registrar who will go to METs - unless they are busy, then it will be your job. If you don’t know Bendigo hospital, don’t worry, you will always be going with an ICU nurse
- MET Team= ICU nurse, ICU registrar (or HMO), medical registrar, and home team registrar (or resident/intern)
- If you attend a MET call your role is to assess and manage any critical illness (ABC) and whether the patient needs a higher level of care (ICU, CCU, theatre etc), and also to act as a conduit to ICU- a MET call counts as an ICU referral if the home team / medical registrar asks for an ICU / HDU bed during the MET. If this occurs you will generally call your registrar and have them come and review, however it may be appropriate to call the consultant directly. It is important to note that the medical registrar is essentially the leader of the MET call, and your role is to provide support and assess ABCs.
- Also note that if a patient has more than one MET call during 24 hours, it must be escalated to a home team consultant by the parent team (ie NOT your job) as mortality in multiple MET call patients is approx. 20%, double ICU mortality and approx. 10x ward patient mortality.
- Only Consultants can say yes or no to an ICU bed, so never confirm a response one way or another – we do not have the authority to do so
- The bed state in ICU is often fluid – patients can be sent to the ward if clinically necessary – so in general do not say that we are ‘full’ as people may transfer patients to Melbourne etc. when it could be avoided.
- Just check with your registrar/Consultant who will talk to the ANUM regarding bed state if needed