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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
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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.
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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.
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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
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Evidence base• A very Un-systematic search
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Guidelines
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Expert Opinion
• Discussion with medical and nursing colleagues from Kent Surrey and Sussex.
• Examples of services in the KSS area that were working well.
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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
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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
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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
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Green Tags
• A&E /Emergency Medicine • Paediatrics • Paediatric surgery • Neonatology • Nuclear Medicine
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Tricky areas
• Urology • ENT • Acute oncology• Interventional radiology (including neuro-IR)• MRI Scan • A&E /Emergency Medicine • Others……?
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Summary
• Very little evidence found• Expert opinion• Open to discussion