All admissions to General Critical Care should be discussed with the senior doctor covering the unit

There is a Critical Care Bed Coordinator available on extension 56791.

The Critical Care Bed Coordinator attends the hospital bed meeting and must be informed of all Critical Care admissions, both elective and emergency.

They should also be notified of all Critical Care discharges as soon as the decision to discharge has been made.

Elective admissions

These admissions are usually post-operative patients or transfers/repatriations from other Critical Care units. Admission is subject to bed availability.

All elective  admissions must be pre-booked on the hospital intranet system. Allocation of available beds for elective admissions is a Consultant-led decision.

Any enquiries regarding bed availability for elective admissions from surgeons, anaesthetists, or referring hospitals should be directed to the  consultant intensivist on duty for the day.

There are several Critical Care bed meetings held throughout the day to review and manage Critical Care capacity. The first meeting takes place at 07:45, and the final meeting at 16:30.

Emergency referrals 

A senior Critical Care doctor is responsible for assessing all emergency referred patients. All referrals must be made via bleep 1005 or via the consultant intensivist phone as a Consultant-to-Consultant referral, either from within the hospital or from external units.

Senior resident doctors wishing to be involved in the assessment or management of emergency referrals, should discuss this with the Consultant allocated to referrals at the start of your shift.

All referrals must be discussed with a Consultant.

If a patient requires immediate airway management and you are not a trained advance airway practitioner, you must request immediate assistance from someone with the appropriate training for advance airway management.

If there is a difficult airway emergency outside the critical care units you must call 2222 (cardiac arrest number) and state AIRWAY EMERGENCY and location.

All patient interactions must be clearly documented in the medical notes, including cases where a patient is assessed and Critical Care input is deemed not appropriate.

It is good practice to document the clinical reasoning behind all decisions.

Patient Discharges

A senior critical care  doctor is responsible for deciding when a patient is ready for discharge from Critical Care.

A nurse and medical discharge summary must be completed on the hospital EPR system (MIYA)

All sections must be completed, including full details of the patient’s Critical Care stay and plans for ongoing treatment (for example, microbiology plans and any outstanding results).

The ward doctor responsible for the patient’s ongoing care must also be contacted and a direct verbal handover provided. This should be the ward doctor from the parent consultant team, or the on-call ward doctor if the patient is being discharged near to or out of hours.

A review of the  medication must be done prior to discharge of the patient to the ward environment to ensure that no medications are missed during the transfer from critical care and that all medication and infusions that are only to be given in critical care have been discontinued. If any doubt please consult with the critical care pharmacist.