BH ICU Manual
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      • Admissions & Discharges
      • Admission guidelines for surgical elective and emergency operations
    • Admission guidelines for surgical elective and emergency operations
    • Daily ICU review & care
      • FAST HUGS IN BED PLEASE
      • Oxygen prescribing
      • Oxygen - Paediatric considerations
      • Care of the Invasively Ventilated Patient – Adult Patient (PROMPT)
      • Assessing for extubation
      • Nutrition in ICU
      • Thiamine prescribing
    • Care bundle
      • Post-cardiac arrest care (TTM) (PROMPT)
      • Care of the Post-Operative Patient
      • Spinal Trauma- CPG's (includes cervical spine clearance) (PROMPT)
      • Management Of Uncontrolled, Life Threatening Bleeding (Massive Exsanguination) (PROMPT)
    • Clinical Protocols + Guidelines
      • RAPID COVID, INFLUENZA AND RSV TESTING
      • Approach to patient with suspected influenza
      • Stroke Protocol (SCV Oct 2018)
    • NIV
      • Domiciliary (Home) non-invasive ventilation (NIV)/CPAP patients
      • NIV (PROMPT)
    • Tracheostomy Management
    • PICCO decision making tree
    • CRRT
    • Procedures
    • Patient transfers
      • Emergency calls to the helicopter pad
      • Transferring ICU patients
        • Intra & Interhospital transfers
        • MRI transfers - special considerations
    • Welfare & other supports for patients and family
      • Social work, pastoral care & aboriginal hospital liaison officer support
      • Interpreter services
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        • Learning and Training in ICU
        • Bendigo Health ICU Medical Education Principles
          • Departmental overview
          • Medical Stream
          • Medical Weekly Schedule
            • Wednesdays
            • Airway training (hands-on-real time) in Operating theatre
            • Radiology Conference
            • ‘Labs/lytes’ session or equipment or Journal club
            • Tracheostomy day for doctors
            • Deteriorating patient workshop
            • Ambu Bronchoscope and Cook Surgical Airway CPD workshop
            • Crucial Conversation workshop
            • Team Skills simulation day
            • ALS Simulation
            • Level 1 ECHO training
            • External Speakers
            • VICEN
            • Bendigo ICU Journal club
          • Expectations for Consultants
          • Expectations for all ICU Registrars
          • Expectations for HMOs
          • Medical Student program
          • North West Training Hub
          • ICU Simulation
        • Curated educational videos & websites
          • Virtual bronchoscopy
        • Mandatory training for medical staff
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        • Registrar Assessments and In-Training Evaluation Reports (ITERs)
        • Registrar term assessments (consultant access only)
          • Term Assessment form (consultant access only)
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      • Paediatric crit care education
      • Useful learning links
    • Research & Quality
      • Research
        • Recent Publications
    • Well-being
      • Mentorship
      • Looking after yourself and colleagues
    • Medical Students in ICU
  • Paediatric ICU
    • Introduction
    • GO NOW Criteria
    • Admission criteria for paediatric HDU/ICU
    • Commonly used SCV Paediatric Guidelines
      • Asthma
      • Bronchiolitis
        • Bronchiolitis
        • Respiratory Distress Score for monitoring patients with bronchiolitis on HFNC and CPAP
      • Croup
      • Diabetic ketoacidosis
        • Algorithm for the management of DKA (to be read in conjunction with SCV guideline)
        • SCV - Diabetic ketoacidosis
      • Seizures
        • Febrile seizures
        • Non-febrile seizures
      • The Septic Child
        • Assessment & Management (SCV)
        • Criteria for rapid ICU admission of children with sepsis
      • Dehydration
        • Dehydration
        • IV fluid management
    • Paediatric Resus Card
  • Emergency!
    • Code Blue: ALS algorithms
      • Adult ALS algorithm
      • Paediatric ALS algorithm
      • Obstetric cardiac arrest flowchart
    • Emergency algorithms/mnemonics
      • Airway
      • Breathing
      • Circulation
      • Disability
    • MET calls: common scenarios
      • Staff concern
      • Hypoxic Type 1 Respiratory Failure
      • Hypercapnoeic Type 2 Respiratory Failure
      • Atrial Fibrillation
      • Hypotension and CV Shock
      • Altered consciousness
      • The Agitated Patient
      • Interface with other disciplines
      • Oliguria/Anuria
    • MET calls: resources
    • Paediatric Resus Card
  • Home
  • Administration
    • Team members
    • Useful contacts
    • Orientation & Guides
    • Roster rules for ICU junior doctors (Appendix A)
    • App user tips
      • FindMyShift
      • Kronos
      • Synapse
      • Offsite access to additional email addresses
    • VHIMS
      • VHIMS Resources (intranet only)
      • How to enter a VHIMS (intranet only)
    • Social Media Etiquette
    • BASIC equipment loan
    • Medical Students in ICU
    • ICU Consultants Only
      • Echuca Telehealth Consults
      • Shift swap form for consultants
      • CME Claim Process
    • ERH VITCCU
  • Clinical
    • Interface with ED & home teams
      • ED
      • Surgical teams
      • Cardiology
      • Paediatrics
    • Admissions & Discharges
      • Admissions & Discharges
      • Admission guidelines for surgical elective and emergency operations
    • Admission guidelines for surgical elective and emergency operations
    • Daily ICU review & care
      • FAST HUGS IN BED PLEASE
      • Oxygen prescribing
      • Oxygen - Paediatric considerations
      • Care of the Invasively Ventilated Patient – Adult Patient (PROMPT)
      • Assessing for extubation
      • Nutrition in ICU
      • Thiamine prescribing
    • Care bundle
      • Post-cardiac arrest care (TTM) (PROMPT)
      • Care of the Post-Operative Patient
      • Spinal Trauma- CPG's (includes cervical spine clearance) (PROMPT)
      • Management Of Uncontrolled, Life Threatening Bleeding (Massive Exsanguination) (PROMPT)
    • Clinical Protocols + Guidelines
      • RAPID COVID, INFLUENZA AND RSV TESTING
      • Approach to patient with suspected influenza
      • Stroke Protocol (SCV Oct 2018)
    • NIV
      • Domiciliary (Home) non-invasive ventilation (NIV)/CPAP patients
      • NIV (PROMPT)
    • Tracheostomy Management
    • PICCO decision making tree
    • CRRT
    • Procedures
    • Patient transfers
      • Emergency calls to the helicopter pad
      • Transferring ICU patients
        • Intra & Interhospital transfers
        • MRI transfers - special considerations
    • Welfare & other supports for patients and family
      • Social work, pastoral care & aboriginal hospital liaison officer support
      • Interpreter services
      • Patient relations office
  • Beyond Clinical
    • Education & Training
      • Education & Training
        • Learning and Training in ICU
        • Bendigo Health ICU Medical Education Principles
          • Departmental overview
          • Medical Stream
          • Medical Weekly Schedule
            • Wednesdays
            • Airway training (hands-on-real time) in Operating theatre
            • Radiology Conference
            • ‘Labs/lytes’ session or equipment or Journal club
            • Tracheostomy day for doctors
            • Deteriorating patient workshop
            • Ambu Bronchoscope and Cook Surgical Airway CPD workshop
            • Crucial Conversation workshop
            • Team Skills simulation day
            • ALS Simulation
            • Level 1 ECHO training
            • External Speakers
            • VICEN
            • Bendigo ICU Journal club
          • Expectations for Consultants
          • Expectations for all ICU Registrars
          • Expectations for HMOs
          • Medical Student program
          • North West Training Hub
          • ICU Simulation
        • Curated educational videos & websites
          • Virtual bronchoscopy
        • Mandatory training for medical staff
      • Term Assessments
        • Registrar Assessments and In-Training Evaluation Reports (ITERs)
        • Registrar term assessments (consultant access only)
          • Term Assessment form (consultant access only)
      • BASIC Provider & Instructor Courses
      • Paediatric BASIC Provider & Instructor Courses
      • Other education opportunities
      • Paediatric crit care education
      • Useful learning links
    • Research & Quality
      • Research
        • Recent Publications
    • Well-being
      • Mentorship
      • Looking after yourself and colleagues
    • Medical Students in ICU
  • Paediatric ICU
    • Introduction
    • GO NOW Criteria
    • Admission criteria for paediatric HDU/ICU
    • Commonly used SCV Paediatric Guidelines
      • Asthma
      • Bronchiolitis
        • Bronchiolitis
        • Respiratory Distress Score for monitoring patients with bronchiolitis on HFNC and CPAP
      • Croup
      • Diabetic ketoacidosis
        • Algorithm for the management of DKA (to be read in conjunction with SCV guideline)
        • SCV - Diabetic ketoacidosis
      • Seizures
        • Febrile seizures
        • Non-febrile seizures
      • The Septic Child
        • Assessment & Management (SCV)
        • Criteria for rapid ICU admission of children with sepsis
      • Dehydration
        • Dehydration
        • IV fluid management
    • Paediatric Resus Card
  • Emergency!
    • Code Blue: ALS algorithms
      • Adult ALS algorithm
      • Paediatric ALS algorithm
      • Obstetric cardiac arrest flowchart
    • Emergency algorithms/mnemonics
      • Airway
      • Breathing
      • Circulation
      • Disability
    • MET calls: common scenarios
      • Staff concern
      • Hypoxic Type 1 Respiratory Failure
      • Hypercapnoeic Type 2 Respiratory Failure
      • Atrial Fibrillation
      • Hypotension and CV Shock
      • Altered consciousness
      • The Agitated Patient
      • Interface with other disciplines
      • Oliguria/Anuria
    • MET calls: resources
    • Paediatric Resus Card

Introduction

Outreach is now a registrar led, consultant supported service. The outreach consultant fulfils the following roles –
  • Responding to MET and Code Blue calls during the weekday morning ward round if no outreach registrar available. You will carry the Outreach ICU registrar’s phone during this time.
  • Support the ICU outreach registrar.
  • Support the Duty Intensivist – particularly if the unit is busy, you may be asked to assist ICU ward patients (procedures, viz tracheostomies) and outside of unit (referrals, management of critically ill patient on the ward who is awaiting ICU admission)
  • Attendance on the Nutritional Support Service from 0900 Friday to review TPN patients
  • Attend Pre-admission clinic on Tuesdays
  • Backfill Duty Intensivist role if unplanned leave (including recuperation if busy night)

Outreach Ward Round
This covers the following areas –
  • ICU discharges – review until risk of ICU admission has reached that of general ward population
  • MET call patients – ICU LN will ask you to review high risk or problematic patients (many of whom have inadequate / unclear resuscitation planning)
  • Refused or declined referrals (including those still in ED)
  • Nutrition support (primarily TPN) – dietitian accompanies you on this part of the round.
  • Tracheostomy service
  • Vascular access service

ICU Outreach registrar
The outreach registrar’s primary roles are to –
  • Respond to all Code Blues, MET and level 1 and 2 Trauma calls
  • Insert PICC and CVC lines on non-ICU patients
  • Support the ICU Outreach consultant and Liaison Nurse
  • Check and re-stock the PICC, Paediatric and Airway Trolleys once per week (Thursday).

When there is no outreach registrar
When there is no Outreach registrar, the Outreach consultant will hold the phone (and therefore fulfil all responsibilities of the Outreach registrar) for 0900-1100 for Monday - Friday (excepting public holidays). These responsibilities include –
  1. Responding to MET (within 5 minutes) and Code Blue (immediately) calls
  2. Receiving and reviewing referred patients (within 30 minutes)
  3. Supporting the ICU LN, particularly during their morning round reviewing the following patients (this may or may not require the Outreach consultant to physically attend the round, but they must attend if requested by the ICU LN or dietitian) -
  1. TPN patients 
  2. Post-discharge patients
  3. Post-MET call patients     
  4. Patients with central venous access (excluding oncology PICC lines)
  5. ​Patients with a tracheostomy

The Outreach consultant holds the phone during teaching and fulfills all responsibilities of the Outreach registrar​.

Outside of these hours where they hold the phone (1100-1600 (1700 on Wednesday)) the Outreach consultant will 
  1. Attend pre-admission clinic on Tuesday afternoon
  2. Facilitate PICC line insertions
  3. Review referrals for TPN and PICC lines
  4. Support the ICU team as required - this may need the Outreach phone needs to be held beyond 1100 
  5. Attend MET and Code Blue meetings (this includes those occurring during any meetings that the Outreach consultant may be attending)
  6. Support the ICU LN as required

If there is a commitment for which the Outreach consultant could not leave immediately (i.e. Code Blue) then they must arrange cover and notify the ICU LN (extension 47936) 

Vascular access service
Historically, ICU has provided vascular access to the hospital, primarily via PICC lines but also CVCs as needed (note: oncology insert their own PICC lines)

There is a two-step process –
  1. Authorise the PICC line – some requests are unreasonable (ie. < 1 week antibiotics in an inpatient with no vascular access issues, or could be managed with oral antibiotics)
  2. Organise insertion – this can be organised to be done by (in order) –
  • The ICU Outreach registrar
  • Radiology (LN will phone and try and book spot)                        
  • You

There must be a clear plan for the insertion of a PICC line at the end of each outreach shift. Any PICCs approved by you and with no definitive plan for insertion must be handed over to the next day’s ICU outreach consultant (if it is not you).

Do not organise to insert PICC lines after 1400 on days where there is no evening LN. This practice leads to unnecessary overtime for the LNs.
  • Home
  • Administration
    • Team members
    • Useful contacts
    • Orientation & Guides
    • Roster rules for ICU junior doctors (Appendix A)
    • App user tips
      • FindMyShift
      • Kronos
      • Synapse
      • Offsite access to additional email addresses
    • VHIMS
      • VHIMS Resources (intranet only)
      • How to enter a VHIMS (intranet only)
    • Social Media Etiquette
    • BASIC equipment loan
    • Medical Students in ICU
    • ICU Consultants Only
      • Echuca Telehealth Consults
      • Shift swap form for consultants
      • CME Claim Process
    • ERH VITCCU
  • Clinical
    • Interface with ED & home teams
      • ED
      • Surgical teams
      • Cardiology
      • Paediatrics
    • Admissions & Discharges
      • Admissions & Discharges
      • Admission guidelines for surgical elective and emergency operations
    • Admission guidelines for surgical elective and emergency operations
    • Daily ICU review & care
      • FAST HUGS IN BED PLEASE
      • Oxygen prescribing
      • Oxygen - Paediatric considerations
      • Care of the Invasively Ventilated Patient – Adult Patient (PROMPT)
      • Assessing for extubation
      • Nutrition in ICU
      • Thiamine prescribing
    • Care bundle
      • Post-cardiac arrest care (TTM) (PROMPT)
      • Care of the Post-Operative Patient
      • Spinal Trauma- CPG's (includes cervical spine clearance) (PROMPT)
      • Management Of Uncontrolled, Life Threatening Bleeding (Massive Exsanguination) (PROMPT)
    • Clinical Protocols + Guidelines
      • RAPID COVID, INFLUENZA AND RSV TESTING
      • Approach to patient with suspected influenza
      • Stroke Protocol (SCV Oct 2018)
    • NIV
      • Domiciliary (Home) non-invasive ventilation (NIV)/CPAP patients
      • NIV (PROMPT)
    • Tracheostomy Management
    • PICCO decision making tree
    • CRRT
    • Procedures
    • Patient transfers
      • Emergency calls to the helicopter pad
      • Transferring ICU patients
        • Intra & Interhospital transfers
        • MRI transfers - special considerations
    • Welfare & other supports for patients and family
      • Social work, pastoral care & aboriginal hospital liaison officer support
      • Interpreter services
      • Patient relations office
  • Beyond Clinical
    • Education & Training
      • Education & Training
        • Learning and Training in ICU
        • Bendigo Health ICU Medical Education Principles
          • Departmental overview
          • Medical Stream
          • Medical Weekly Schedule
            • Wednesdays
            • Airway training (hands-on-real time) in Operating theatre
            • Radiology Conference
            • ‘Labs/lytes’ session or equipment or Journal club
            • Tracheostomy day for doctors
            • Deteriorating patient workshop
            • Ambu Bronchoscope and Cook Surgical Airway CPD workshop
            • Crucial Conversation workshop
            • Team Skills simulation day
            • ALS Simulation
            • Level 1 ECHO training
            • External Speakers
            • VICEN
            • Bendigo ICU Journal club
          • Expectations for Consultants
          • Expectations for all ICU Registrars
          • Expectations for HMOs
          • Medical Student program
          • North West Training Hub
          • ICU Simulation
        • Curated educational videos & websites
          • Virtual bronchoscopy
        • Mandatory training for medical staff
      • Term Assessments
        • Registrar Assessments and In-Training Evaluation Reports (ITERs)
        • Registrar term assessments (consultant access only)
          • Term Assessment form (consultant access only)
      • BASIC Provider & Instructor Courses
      • Paediatric BASIC Provider & Instructor Courses
      • Other education opportunities
      • Paediatric crit care education
      • Useful learning links
    • Research & Quality
      • Research
        • Recent Publications
    • Well-being
      • Mentorship
      • Looking after yourself and colleagues
    • Medical Students in ICU
  • Paediatric ICU
    • Introduction
    • GO NOW Criteria
    • Admission criteria for paediatric HDU/ICU
    • Commonly used SCV Paediatric Guidelines
      • Asthma
      • Bronchiolitis
        • Bronchiolitis
        • Respiratory Distress Score for monitoring patients with bronchiolitis on HFNC and CPAP
      • Croup
      • Diabetic ketoacidosis
        • Algorithm for the management of DKA (to be read in conjunction with SCV guideline)
        • SCV - Diabetic ketoacidosis
      • Seizures
        • Febrile seizures
        • Non-febrile seizures
      • The Septic Child
        • Assessment & Management (SCV)
        • Criteria for rapid ICU admission of children with sepsis
      • Dehydration
        • Dehydration
        • IV fluid management
    • Paediatric Resus Card
  • Emergency!
    • Code Blue: ALS algorithms
      • Adult ALS algorithm
      • Paediatric ALS algorithm
      • Obstetric cardiac arrest flowchart
    • Emergency algorithms/mnemonics
      • Airway
      • Breathing
      • Circulation
      • Disability
    • MET calls: common scenarios
      • Staff concern
      • Hypoxic Type 1 Respiratory Failure
      • Hypercapnoeic Type 2 Respiratory Failure
      • Atrial Fibrillation
      • Hypotension and CV Shock
      • Altered consciousness
      • The Agitated Patient
      • Interface with other disciplines
      • Oliguria/Anuria
    • MET calls: resources
    • Paediatric Resus Card