Co-dependencies for critical care patients

Mansoor SangeDarent Valley Hospital, Dartford

South East Coast Clinical Senate Defining the clinical co-dependencies of acute hospital services

10th September 2014

Task

• To identify what services are essential for the safe provision of critical care services

• Do these services need to be co-located with the critical care unit or can they be provided on a network basis?

• I understand that this is different “what services require a critical care unit to support them?”

• The difference is probably not always useful.

My Approach

• Try to understand the question asked• Identify the sources of help / evidence.• Read, read, read.• Collate the useful bits.• Discuss with medical and nursing colleagues

from Kent, Surrey and Sussex• Identify the tricky issues• Hope to achieve consensus.

Evidence base

• Systematic search kindly provided by Tom Roper

• Identified a few papers.• Useful in identifying the specialities that need

critical care but not the other way round.• Included

Evidence base• A very Un-systematic search

Guidelines

Expert Opinion

• Discussion with medical and nursing colleagues from Kent Surrey and Sussex.

• Examples of services in the KSS area that were working well.

Red Tags• Acute General Medicine• Elderly Medicine • Respiratory Medicine • Gastroenterology (and urgent

endoscopy) • Diabetes and endocrinology • Gynaecology• General Surgery (upper GI and

lower GI) • Trauma • Orthopaedics• Urology • ENT • General Anaesthetics

• Inpatient nephrology • Acute oncology• Palliative care • Neurology • Diagnostic radiology / CT Scan • Interventional radiology (including

neuro-IR)• microbiology, Urgent diagnostic

Haematology and Biochemistry• Transfusion, and Blood Bank • Acute in patient Rehabilitation • Physiotherapy / Speech and

language / Dietetics• Acute mental health services

Red Tags• Acute General Medicine• Elderly Medicine • Respiratory Medicine • Gastroenterology (and urgent

endoscopy) • Diabetes and endocrinology • Gynaecology• General Surgery (upper GI and

lower GI) • Trauma • Orthopaedics• Urology • ENT • General Anaesthetics

• Inpatient nephrology • Acute oncology• Palliative care • Neurology • Diagnostic radiology / CT Scan • Interventional radiology (including

neuro-IR)• microbiology, Urgent diagnostic

Haematology and Biochemistry• Transfusion, and Blood Bank • Acute in patient Rehabilitation • Physiotherapy / Speech and

language / Dietetics• Acute mental health services

Amber Tags

• Rheumatology • Dermatology • Maxillo-facial surgery • Hub vascular surgery • Spoke vascular surgery • Neurosurgery

• Plastic surgery • Burns • Inpatient dialysis • MRI Scan • Cardiac MRI • Occupational Therapy

Green Tags

• A&E /Emergency Medicine • Paediatrics • Paediatric surgery • Neonatology • Nuclear Medicine

Tricky areas

• Urology • ENT • Acute oncology• Interventional radiology (including neuro-IR)• MRI Scan • A&E /Emergency Medicine • Others……?

Summary

• Very little evidence found• Expert opinion• Open to discussion