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

There is a critical care bed manager that carries bleep 1008. The critical care bed manager attends the hospital bed meeting and needs to be informed of all critical care admissions, elective and emergency, as well as critical care discharges as soon as decission to discharge has been made.

Elective admissions

These are usually post-operative patients or transfers / repatriations from other critical care units. Admission will be dependent on bed availability.

All admissions are booked on the Apollo system which is available on the home intranet page. It is a Consultant decision to allocate available beds to elective admissions. Please direct surgeons, anaesthetists or referring hospitals who are asking about bed availability for elective admissions to the appropriate consultant. There are several critical care bed meeting along the day to discuss critical care capacity, the first one at 7:45am and the latest one at 16:30. 

Emergency referrals 

A senior critical care doctor is responsible for assessing all patients who are referred. All referrals should come via the 1005 bleep or via Consultant to Consultant from inside the hospital or external units.

Please discuss with the Consultant allocated to referrals at the start of the shift if you want to be involved with the assessment / management of emergency referrals.

All referrals MUST be discussed with the Consultant. If the patient needs immediate airway management and you are not an anaesthetist then you should bleep the 3rd on-call anaesthetist on bleep 4598 or activate the emergency airway bleep on extension 2323. 

All interactions with patients must be documented in the medical notes (including occasions when the patient is assessed and critical care input is not appropriate). It is useful to document the reasons behind the decision making. 

Patient Discharges

It is a senior ICU Doctor who decides when a patient is ready for discharge from critical care. A discharge summary is printed from the ward watcher system:

• Click on the ward watcher ‘4D’ icon if not already open (see current password list for logon code). 
• Click on the appropriate unit from the tool bar across the top, click the ‘beds’ icon. 
• Select the appropriate patient by clicking on their name in the bed space. 
• Click on ‘discharge’ in the bottom right hand corner of the screen. 
• Click on ‘print transfer’ in the bottom right hand corner of the screen
  

Two pre-formatted pages will be printed. These pages make up the discharge summary for the ward. Please fill out all sections, include all relevant information regarding the patients’ critical care stay and plans for ongoing treatment e.g: Microbiology plans, outstanding results awaited etc. The ward Doctor who will be looking after the patient should be contacted and spoken to directly. This is the ward Doctor of the parent Consultant team and or the on-call Doctor for the ward if the Patient is being discharged near to or out-of-hours. A ward medicine kardex should be completed so that transfer from critical care does not result in missed medication.