Up to date from 21/07/20 - as per J Fletcher in collaboration with the depts of surgery and anaesthetics
Admission guidelines for Post-op surgical patients
-Elective operations
-Emergency operations
-Unexpected referrals from theatre
-Transfer to SJOG
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.
Unexpected ICU referrals from theatre.
Initial Communication:
If admission is agreed but there may be a delay for bed management after hours:
If the patient is to be transferred to SJOG post-operatively
If a doctor escort is required:
In-hours:
After-hours:
If the patient is to be transferred to any other ICU:
- Anaesthetist calls ICU Registrar on call – ICU registrar will discuss referral with ICU consultant.
- If ICU Consultant does not agree with need for admission to ICU, Anaesthetic Consultant and ICU Consultant must make direct contact and discuss the case.
- Once there is clinical agreement to admit to BH ICU, Anaesthetist contacts Theatre Floor Coordinator to make bed arrangements.
If admission is agreed but there may be a delay for bed management after hours:
- If patient NOT intubated: they can be managed in PACU.
- NB operating will have to stop after the next case ends due to PACU staffing requirements.
- If patient is intubated, there may be interruption of operating until the ICU bed becomes available, as the Anaesthetic Consultant will need to manage the intubated patient until the ICU bed becomes available.
- In this case the ICU Access nurse may be required to manage the patient in ICU until the bed issue is resolved (rather than interrupting emergency operations).
If the patient is to be transferred to SJOG post-operatively
- Anaesthetist to discuss with Intensivist on call.
- Intensivist on call will discuss with SJOG Intensivist, and determine need for escort and level of escort (registrar or consultant).
- Surgeon to arrange Surgical cover at SJOG.
- ICU to call AV and arrange transport.
If a doctor escort is required:
In-hours:
- Duty Anaesthetist or Duty Anaesthetic Registrar
After-hours:
- If theatre is busy and there are more cases to do, should preferably be an ICU doctor.
- If the ICU case is the last case (i.e. no more theatre cases), the Anaesthetic Registrar or Consultant should escort.
- If the Anaesthetic Registrar escorts, the Anaesthetic Consultant must be available for epidurals & codes until the registrar returns.’’
If the patient is to be transferred to any other ICU:
- Anaesthetist calls ARV directly and refers the patient.
- ARV will usually contact the Surgeon for a surgical handover.