Courtesy of Dr Jason Fletcher and Dr Emma Broadfield, 2016
Guideline to Surgical Admissions
1. All referrals to ICU from theatre for patients having unplanned surgery are accepted unless one of the following occurs –
- There are no ICU beds but ICU remains involved to advise appropriate disposition (inter-hospital transfer or ward)
- There is suspicion that the patient may not require ICU admission. The Duty Intensivist is responsible for assessing the patient in Recovery (PACU) and discuss their assessment with the referring doctor or team (ie surgeon and / or anaesthetist).
2. The anaesthetic team maintains responsibility for clinical decisions regarding whether the patient initially remains intubated.
3. Where there is uncertainty, to encourage the anaesthetic team to consider inserting a CVC whilst in theatre (with preference for a quad-lumen CVC).
4. To actively encourage surgeons to operate on critically ill patients even if an ICU bed is not guaranteed.
5. Elective referrals need to be entered into the ANUM Allocation book, and documentation placed in the 'Bart Simpson' folder.
6. Over 90% of elective surgical patients are seen in the ICU Pre-Admission Clinic, if accepted for HDU/ICU admission, they are assigned 1 of 2 categories: (the ICU Liaison Nurse assists with organising the required paperwork)
3. Where there is uncertainty, to encourage the anaesthetic team to consider inserting a CVC whilst in theatre (with preference for a quad-lumen CVC).
4. To actively encourage surgeons to operate on critically ill patients even if an ICU bed is not guaranteed.
5. Elective referrals need to be entered into the ANUM Allocation book, and documentation placed in the 'Bart Simpson' folder.
6. Over 90% of elective surgical patients are seen in the ICU Pre-Admission Clinic, if accepted for HDU/ICU admission, they are assigned 1 of 2 categories: (the ICU Liaison Nurse assists with organising the required paperwork)
- 'Accepted, but if no bed available - recommendation that planned surgery be CANCELLED/POSTPONED'
- 'Accepted, but if no bed available - recommendation that planned surgery may PROCEED'
Flow chart, courtesy of Dr Emma Broadfield, 2016