Up to date from 14/5/20 - as per J Fletcher in collaboration with the depts of surgery and anaesthetics
Admission guidelines for surgical elective and emergency operations
Planned (elective) surgery
All planned surgical referrals to ICU should be referred to the High Risk Pre-Anaesthetic Clinic held each Tuesday, staffed by both an Anaesthetist and an Intensivist.
Patients having the following surgeries require post-operative admission to ICU regardless of their age or co-morbid status -
1. Gastro-oesophagectomy
2. Any lung resection (wedge resection, lobectomy or pneumonectomy)
3. Cystectomy
4. Anterior resections (including low or ultra-low anterior resection)
Other planned laparotomy surgery (colectomy, APR and other) do not require referral for post-operative admission to ICU unless deemed to be high risk due to age and/or co-morbid factors.
For all patients accepted for ICU admission post-operatively, surgery should commence without regard to ICU capacity or the need to contact ICU or the bed manager. ICU will ensure that patients approved for ICU admission post-operatively are admitted to ICU in a timely fashion post-operatively.
All planned surgical referrals to ICU should be referred to the High Risk Pre-Anaesthetic Clinic held each Tuesday, staffed by both an Anaesthetist and an Intensivist.
Patients having the following surgeries require post-operative admission to ICU regardless of their age or co-morbid status -
1. Gastro-oesophagectomy
2. Any lung resection (wedge resection, lobectomy or pneumonectomy)
3. Cystectomy
4. Anterior resections (including low or ultra-low anterior resection)
Other planned laparotomy surgery (colectomy, APR and other) do not require referral for post-operative admission to ICU unless deemed to be high risk due to age and/or co-morbid factors.
For all patients accepted for ICU admission post-operatively, surgery should commence without regard to ICU capacity or the need to contact ICU or the bed manager. ICU will ensure that patients approved for ICU admission post-operatively are admitted to ICU in a timely fashion post-operatively.
Unplanned (emergency) surgery
All patients requiring invasive ventilation will be admitted to ICU - there is no requirement to review these patients in recovery.
All patients requiring 1:2 (HDU) care and who are referred to ICU by anaesthetics should be accepted for admission unless there is limited ICU capacity (defined as < 1 HDU bed remaining after all available patients suitable for ward transfer have been accounted for).
If there is limited ICU capacity, or the patients have been referred by the surgical unit, these patients should be reviewed by the ICU registrar in recovery and discussed with the ICU consultant (or ICU consultant when there is the intent to to refuse request by anaesthetics for ICU admission due to lack of ICU capacity).
As with other refused requests for ICU admission, the ICU consultant must be notified as well as the referring unit. Any dispute or disagreement must be escalated to the ICU consultant as soon as practicable.
All patients requiring invasive ventilation will be admitted to ICU - there is no requirement to review these patients in recovery.
All patients requiring 1:2 (HDU) care and who are referred to ICU by anaesthetics should be accepted for admission unless there is limited ICU capacity (defined as < 1 HDU bed remaining after all available patients suitable for ward transfer have been accounted for).
If there is limited ICU capacity, or the patients have been referred by the surgical unit, these patients should be reviewed by the ICU registrar in recovery and discussed with the ICU consultant (or ICU consultant when there is the intent to to refuse request by anaesthetics for ICU admission due to lack of ICU capacity).
As with other refused requests for ICU admission, the ICU consultant must be notified as well as the referring unit. Any dispute or disagreement must be escalated to the ICU consultant as soon as practicable.