General Surgery
Agreed collaborative approach as of 19 June 2019:

Information sharing:

1. Surgical team to provide CLINICAL handover to the ICU registrar or consultant for ALL surgical patients admitted to ICU, to include:
  • Anticoagulation plan
  • Drain management
  • Nutritional plan
  • Any other specific requests for reporting or management of surgical issues in the next 24 hours (e.g. skin flap obs)
  • Encourage surgical team to share their ward round/review assessments and plans with the ICU staff AT THE TIME OF ASSESSMENT prior to departing the ICU, this may include attending during ICU morning group handover (0800-0830).  The ICU consultant needs to avail themselves for discussion if the handover cannot be disrupted otherwise.
  • Timely integration of surgical clinical care suggestions
2. Conflicts in decision making:
  • Escalated through the usual medical hierarchy in a timely and respectful manner (i.e. registrar to consultant to Clinical Heads), and utilise VHIMS.
3. Abdominal imaging:
  • To be discussed with the surgical team prior to any imaging to ensure appropriate clinical questions are addressed in the imaging
4. Prescribing:
  • As per usual – only ICU medical staff can amend or add to the prescription chart
5. Therapeutic anticoagulation:
  • If within first week post-procedure is to be discussed with the responsible surgical team before commencement
6. Nutrition:
  • TPN – to be prescribed and amended by ICU team only (this includes potassium management where it is added to the TPN; responsibility for management of other electrolytes is shared with the surgical team)
    • Note: senior dietician, Lauren Ballantyne, is qualified to prescribe ongoing TPN, but the first prescription must be made by a doctor
  • Alternate management for patients on or considered for TPN is to be escalated to the Outreach team or weekend ICU team
  • Post-op nutrition to be as per surgical nutritional plan
  • If no documented plan in PLANNED LOWER GIT SURGERY:
    • Day 0 - Fluids
    • Day 1 – diet as tolerated
  • UNPLANNED lower GIT surgery – to be discussed with the surgical team
  • Complex nutritional plans – needs input from dietician, nursing, ICU medical input and surgical input
7. Drain and wound management – as per surgeons
8. Don’t use laxatives without talking to surgeons (particularly stimulants post-anastomosis)
Orthopaedics
  • Usually permit up to 24 hours of antibiotic prophylaxis
Urology
  • Similar to General Surgery with further directed advice regarding areas such as nutrition (usually more conservative then in general surgical patients), much more conservative with vasopressors (after certain procedures i.e. ileal conduit formation) and epidurals (noting various preferences by different urologists)