Transcript Co-dependencies FOR critical care patients

Co-dependencies for critical care
patients
Mansoor Sange
Darent 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
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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
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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
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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
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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
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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
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Rheumatology
Dermatology
Maxillo-facial surgery
Hub vascular surgery
Spoke vascular surgery
Neurosurgery
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Plastic surgery
Burns
Inpatient dialysis
MRI Scan
Cardiac MRI
Occupational Therapy
Green Tags
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A&E /Emergency Medicine
Paediatrics
Paediatric surgery
Neonatology
Nuclear Medicine
Tricky areas
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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