Westmead ICU Admission and Discharge Procedures by lindayy


Westmead ICU Admission and Discharge Procedures

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                                     Document Management
                   Westmead ICU Admission and Discharge Procedures
                         DocumentID:      PROC10929

                     Alternative Title:

              Creator Corporate Name:     Sydney West Area Health Service

                               Author:    Edward Stachowski

           Author Department Address:     ICU, E Block, Level 3, Westmead Hospital

                      Author Position:    Director Intensive Care, Westmead Hospital

                      Author Contact:     9845 9363

                        Author Email:     eddie_stachowski@wsahs.nsw.gov.au

                          Contributor:    Bryan McKee-Hata

                        Endorsement:      Executive Director Clinical Operations

                            Publisher:    Sydney West Area Health Service

                              Subject:    Admission and discharge procedures

                           Keywords:      ICU; Admission; Discharge

                          Description:    Westmead ICU Admission and Discharge Procedures.

                      Version History:    Version 1

                            Category:     Access and Patient Logistics (APL)

                      ClassificationID:   PROC

                              Source:     Westmead ICU

                        Date Created:     1 January 2008

                       Date Modified:     1 January 2008

                     Date Valid From:     9 February 2009

                        Date Valid To:    1 January 2011

                         Date Issued:     9 February 2009

                          IdentifierID:   (0)

                    Identifier Number:    N/A

                    TRIM File Number:     FILE07/1172

                TRIM Record Number:       PP08/750

                          Availability:   Online: Yes, Via Stores Request: No, Hosprint Print Request: No

                                          Elizabeth Scott
                                          EA to ED, Clinical Operations
                         Key Contact:
                                          4734 1366

                         LanguageID:      English (1)

                          AudienceID:     SWAHS Employees (1)


http://westnet/swahsdocuments/management/metadata/PROC10929.htm                                             13/02/2009

 Westmead ICU Admission and Discharge Procedures

                              Date Created: January 2008
                                    Last Updated:

Copyright SWAHS                                            Page 1 of 5
Westmead ICU Admission and Discharge Procedures
Date Created: January 2008
Last Updated:

   1) Patients admitted to the Intensive Care Unit must have an acute, potentially
      reversible, life-threatening illness requiring the following medical therapies not
      offered outside the ICU as part of their clinical management:
          a) Endotracheal intubation;
          b) Invasive or non-invasive mechanical ventilatory support;
          c) Invasive haemodynamic monitoring and inotropic / vasopressor
          d) Continuous renal replacement therapy

   2) Patients admitted to ICU are admitted under a co-consultant arrangement
      between the Referring Consultant (also known as the Attending Consultant)
      and the ICU Consultant.

   3) Instructions for the admission of patients to the Intensive Care Unit must
      come via Intensive Care Unit medical staff only. Other medical teams must
      liaise with ICU medical staff, who will instruct the ICU nursing staff. It is
      essential for the staff and prudent provision of intensive care services that
      dedicated Specialist Intensivists strictly manage this ‘closed-unit’ policy, to
      ensure that scare and valuable intensive care resources are not deployed in a
      manner that is wasteful or detrimental to patients. Non-ICU medical, nursing
      or administrative staff do not have the authority to dictate the admission of a
      patient to the ICU.

   4) The ICU Consultant or Senior Registrar determines appropriateness of all
      admissions to Westmead ICU. This will be dependent on the patient’s
      severity of illness, need for therapeutic interventions only offered in the ICU
      and potential benefit to the patient of intensive care intervention.

   5) Westmead in-patients who require intensive care support are admitted only
      with the prior knowledge of the Attending Consultant and the ICU Consultant
      or Senior Registrar on duty. The relevant Registrar of the Attending
      Consultant (in-hours) is responsible for the notification of the patient’s
      Attending Consultant, and the relevant specialty Registrar on-site is
      responsible after-hours.

   6) Patients referred from outside Westmead Hospital will only be admitted to
      the ICU once an Attending Consultant and the ICU Consultant or Senior
      Registrar have accepted the patient for admission. The responsibility for
      liaising with the relevant Attending Consultant, or their Registrar, rests with
      the referring medical officer at the referring hospital. At no time is an ICU
      Consultant to be regarded as the Attending Consultant. For further details see
      point 7

   7) If an Attending Consultant has not been allocated to any Intensive Care
      patient transferred from another hospital, then the patient must be transferred
      to the Emergency Department. The relevant specialty Registrar will then be
      involved in the patient’s assessment and allocation / notification of the
      Attending Consultant.

   8) In order to be admitted directly to the ICU from outside Westmead Hospital,
      patients must fulfil the following criteria:

Copyright SWAHS                                                      Page 2 of 5
Westmead ICU Admission and Discharge Procedures
Date Created: January 2008
Last Updated:
       a) They are deemed to be appropriate for admission to ICU by the ICU
          Consultant or Senior Registrar;
       b) They have been accepted by the ICU Consultant or Senior Registrar for
          direct admission to the ICU;
       c) A staffed & terminally cleaned ICU bed area is available;
       d) They have an Attending Consultant who has accepted their care;
       e) They do not require any of the following investigations or procedures

            i) Urgent imaging studies (e.g. CT, MRI or angiography)
            ii) Urgent interventional procedures in either the Radiology Angiography
                 Suite or Cardiac Catheterisation Laboratory
            iii) Urgent Operating Theatre intervention;

       f)   They do not have any of the following conditions
            i)    Trauma
            ii)   Major vascular crisis (eg suspected ruptured AAA) that requires
                  imaging or urgent Operating Theatre intervention
            iii)  Major gastrointestinal bleeding that requires either urgent imaging,
                  angiography or operative intervention
            iv)   Acute coronary syndromes requiring urgent assessment for
            v)    Undiagnosed unconsciousness where in urgent imaging is
                  required to determine whether the patient has a surgical or
                  medical cause, as well as determining who the Attending
                  Consultant will be.

If the above criteria have been fulfilled the admission of the patient to the ICU should
be expedited.

Intensive Care patients from outside Westmead Hospital who do not fulfill the above
criteria are to be transferred to the Emergency Department for assessment by
relevant specialty Registrars and the ICU Registrar. Relevant urgent investigations
and therapeutic interventions are to be expedited. When liaising with the referring
medical office it is essential that the ICU Medical Staff tell the Referring Medical
Officer where to send the patient (i.e. either to the ED or direct to the ICU). If the
patient is to be sent to the ED then the ICU medical officer must ensure the ED
Senior Medical Officer is aware of the impending transfer.

Ultra-urgent transfers, where in the patient’s condition requires timely intervention
that is only available in a tertiary referral centre such as Westmead Hospital, should
still be sent to the Emergency Department even when an ICU bed is not available.
This is to allow for urgent investigations and therapeutic options to occur pending the
potential later available of an ICU bed. The ED Senior Medical Officer must be
notified of the impending transfer by the Referring Medical Officer.


Copyright SWAHS                                                      Page 3 of 5
Westmead ICU Admission and Discharge Procedures
Date Created: January 2008
Last Updated:
11)         When multiple patients are referred at the same time for transfer to
            Westmead ICU, the ICU Consultant or Senior Registrar must take into
            account the severity of illness of the patients and their individual needs in
            order to triage the order in which they are accepted for admission. At times
            when the ICU is full, priority should be given to those that require tertiary
            referral care, those from within the confines of Westmead Hospital and those
            from within our Area Health Service and ‘Default Matrix’ hospitals.

      12)      At times when there is an ICU bed crisis in NSW, urgent transfers may
               need to be accepted into Westmead has been allocated a direct
               responsibility. A ‘Default Matrix Transfer’ can only be invoked by the
               director or Deputy Director of the Aeromedical and Medical Retrieval
               Service (AMRS) [formerly known as the Medical Retrieval Unit or MRU]
               after direct discussion with the referring Medical Officer and the
               relevant Westmead ICU Consultant. In-hours the responsible ICU
               Consultant will be the Coordinating Intensivist. After-hours the responsible
               ICU Consultant will be the Zone B Intensivist. NO ONE OTHER THAN
               Please refer to the section that details issues surrounding a Default Matrix
               Transfer titled “Access to definitive emergency care”

      13)      Elective surgical patients who require ICU admission post-operatively
               must be pre-booked via the established ICU Bed Booking system. All
               elective surgical admissions must be brought to the attention of the NUM
               and Coordinating Intensivist on the morning of surgery to allow for
               appropriate utilization of beds.

      14)      All admissions to the unit must be discussed with the Nurse Unit Manager
               (in-hours) or the Nursing Shift Coordinator (after-hours) prior to the patient
               being accepted for admission. In-hours the NUM will liaise with the ICU
               Senior Nurse Manager.

      15)      Allocation of the zone into which the patient is admitted is under the
               direction of the coordinating Intensivist (in-hours) or the Senior Registrar
               (after-hours), in consultation with the NUM or Shift Coordinator, and is
               dealt with as follows in order of priority:

      a) The zone which has the least number of patient;
      b) If each zone has an equal number of patients, then the zone that has the
         most number of patients booked out;
      c) If each zone has an equal number of patients as well as an equal number of
         patients booked out, then the zone with the lesser acuity as determined by
         the number of ventilated and/or dialysed patients;
      d) If this is still not clear to the senior registrar after-hours they are to seek
         advice from the Zone B ICU consultant, or if it is not clear to the zone B ICU
         consultant then the Medical Director of Intensive Care is to be consulted as a
         last resort.

Copyright SWAHS                                                           Page 4 of 5
Westmead ICU Admission and Discharge Procedures
Date Created: January 2008
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16)        A patient may only be refused admission by the ICU consultant, after
          consultation with the referring medical team, never by the Registrar or
          Senior Registrar alone.

17)       Discharge from ICU can only occur on the order of the ICU Consultant
          responsible for the patient’s care. The ICU Registrar must notify the referring
          medical team, or the relevant after-hours Registrar, of the discharge.

Policy:                                        Westmead ICU Admission & Discharge
Date:                                          Reviewed January 2008
Due for review:                                January 2011
Author:                                        Edward Stachowski
Approval:                                      Edward Stachowski
                                               Bryan McKee-Hata

Version History
Date of Issue           Document          Change Details          Author
9th February 2009       Version 1                                 Edward Stachowski

Copyright SWAHS                                                        Page 5 of 5
Westmead ICU Admission and Discharge Procedures
Date Created: January 2008
Last Updated:

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