Clinical (introduction)

The ICU is a closed unit.  The Duty Intensivist has the authority and responsibility to admit, discharge and manage patient care as seen fit. In practical terms, though some decisions are delegated to the parent unit, many others are made collaboratively. The exceptions to this are the Acute Pain Service and Paediatrics – these teams have the authority to amend drug prescriptions and treatment with the expectation that the duty intensivist or registrar are informed of any changes.

Delegated decisions primarily relate to surgeon management of drains and wounds.

Collaborative decisions may include post-operative feeding, difficult decisions pertaining to admission and changes to goals of care, and other areas requiring specialist input.

All other decisions are made by ICU.  Parent units are not allowed to write on drug charts, or alter patient management without the approval of the ICU team. They are actively encouraged to offer their impression and suggestions (most of which we adopt), and are required to document their notes on a daily basis.  Ideally, the ICU medical staff accompany the parent unit while they review a patient, or at the minimum, liaise with the parent unit prior to their leaving the ICU.