11.ICU admission and D/C

Question 1

Critical Care Admission Criteria

Answer 1

1. From 
OT 
Recovery area
ED
Wards

2. Admitted from Ward
   - ↑Mortality
   Longer hospital stay prior to admission ↑ mortality
3. Because lack beds
   Difficult decisions resourcing
   Timely admission without delay crucial if to benefit
4. May refused admission
   Lack of beds
   Too sick to benefit - futile
5. Others denied
   not sick enough
   ward level satisfactory

Question 2

Critical care admission

Answer 2

All admissions d/w consultant
management plan

S/B consultant w.in 12hours or less

Coping with death home / wards more challenging
small chance recovery - admitted
death better managed

Audit those admitted and then died found profound anomality hours before admission
shortcomings in Mx on ward

Catalyst for outreach and Met teams
evidence not confirmed trial (MERIT)

Question 3

Ensuring successful discharge

Answer 3

D/C ICU

• Condition leading to admission
• resolved & Rx adequately

ICU Consultant feel no longer benefit

Wide variation dc criteria
institution & patient

30% deaths ICU occur after d/c
-process d/c & post ccm care
not ignored when minimising mortality

Question 4

Premature discharge

Answer 4

↑ mortality
readmission

delaying discharge @ night may be important
2200-0700 ideally avoided

Teams should be discussed with ward team & d.c

Readmission ↑ mortality and LOS
planned dc take place when no longer requires

Question 5

Outreach

Answer 5

Outreach responsible f/u d/c patients
link ICU wards
Share CC skill & support patients and ward staff

may reduce icu readmission
improve survival to d.c

Question 6

Patients (&relative)

Answer 6

profound long term psychological + psychical sequalae

• rehab beneficial
• follow clinics - support patients
• rehab guidelines - success d/c & long term improvement
• rehab needs assessed commenced when still in ICU
  commenced on ward
  continued once patient returned to community