5 Service organisation

Providing telephone advice

5.1 Trusts should review their 'management of the deteriorating patient' strategy and use of the track and trigger system (NEWS2 has been endorsed by NHS England/Improvement) to allow for telephone advice rather than face-to-face review from critical care when clinically appropriate. See the NICE guideline on acutely ill adults in hospital for recommendations on identifying patients whose clinical condition is deteriorating or is at risk of deterioration.

5.2 Document referral to and advice from critical care services in a standard format. Where telephone advice from critical care is appropriate this should still be documented in a standard format (see an example of a tool for documentation).

Coordinating best use of critical care resources

5.3 Hospitals should discuss the sharing of resources and the transfer of patients between units, including units in other hospitals, to ensure the best use of critical care within the NHS.

5.4 Data on the availability of critical care beds should be made available to the critical care decision makers and operational management team to facilitate sharing of resources (see table 1 for information on maximising critical care bed usage).

Table 1 Maximising critical care bed usage

Within critical care

Have all patients in critical care been reviewed with clear management plans established for the next 24 hours?

Can any level 2 or level 3 capacity be established in other areas of the hospital?

Can care suitable for particular patients be delivered in any other location - for example, can an enhanced care facility be created?

Are you aware of any capacity in neighbouring units within the network or out of the network?

Can any patients be transferred to other units to improve flow?

Outside critical care

Do you know what demand is occurring or is likely to occur in the rest of the hospital?

Do you know the number of patients for whom escalation to critical care is planned (if required)?

5.5 Include operational delivery networks and equivalent in discussions of mutual aid to ensure patients have access to all available, relevant critical care resource.

Extracorporeal membrane oxygenation

5.6 Be aware that respiratory extracorporeal membrane oxygenation (ECMO) services can advise intensive care clinicians on managing severe acute respiratory failure.

5.7 Be aware that respiratory ECMO services can accept referrals for critically ill patients where:

  • they have potentially reversible severe respiratory failure

  • optimal conventional intensive care management has failed

  • they meet the eligibility criteria for the respiratory ECMO service.

For more information see Management of surge and escalation in critical care services: standard operating procedure for adult respiratory extra corporeal membrane oxygenation.