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 –
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 –
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).
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 –
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.
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 –
- 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)
- 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.