2 Admission to critical care
See the critical care referral algorithm.
2.1 Discuss the risks, benefits and possible likely outcomes of the different treatment options with patients, families and carers using decision support tools (where available) so that they can make informed decisions about their treatment wherever possible. See information to support decision making.
2.2 Involve critical care teams in discussions about admission to critical care for a patient where:
the assessment suggests the person is less frail (for example, a CFS score of less than 5), they are likely to benefit from critical care organ support and they want critical care treatment or
the assessment suggests the person is more frail (for example, a CFS score of 5 or more), there is uncertainty regarding the likely benefit of critical care organ support, and critical care advice is needed to help the decision about treatment.
Take into account the impact of underlying pathologies, comorbidities and severity of acute illness on the likelihood of critical care treatment achieving the desired outcome. [amended 25 March 2020]
2.3 Support non-critical care healthcare professionals to discuss treatment plans with patients who would not benefit from critical care treatment or who do not wish to be admitted to critical care.
2.4 Sensitively discuss a possible 'do not attempt cardiopulmonary resuscitation' decision with all adults with capacity and an assessment suggestive of increased frailty (for example, a CFS score of 5 or more). Include in the discussion:
the possible benefits of any critical care treatment options
the possible risks of critical care treatment options
the possible likely outcomes.
Involve a member of the critical care team if the patient or team needs advice about critical care to make decisions about treatment. [amended 25 March 2020]
2.5 Ensure healthcare professionals have access to resources to support discussions about treatment plans (see for example decision-making for escalation of treatment and referring for critical care support, and an example decision support form).
2.6 Ensure that when treatment outside critical care is the agreed course of action, patients receive optimal care within the ward.