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Delivery Plan for the critically ill
Critical care is a speciality which provides support for patients with acute life-threatening injuries and illnesses. Around 9,000 people require such care each year in Wales.
Currently, critical care beds are not always used appropriately. For example, not all patients in critical care beds require that level of care but are awaiting discharge to wards. The knock-on effect of this can be cancelled operations or transfers to other hospitals due to critical care beds being unavailable.
The configuration of critical care beds is also not at optimum levels – currently, Wales’s critical care beds are spread over 17 sites, rather than concentrated in fewer sites where specialist clinical expertise can be better delivered.
The Welsh Government’s Delivery Plan for the Critically Ill sets out what is required of Local Health Boards by 2016 to make the best use of critical care beds.
It also includes plans to investigate a potential increase in capacity where necessary alongside making better use of existing resources – for example to address an increase in organs donated subject to new legislation being introduced in 2015.
Health Minister Mark Drakeford said:
“Critically ill patients require close, constant attention by a team of specially-trained health professionals.
“NHS Wales has an average of 3.2 critical care beds per 100,000 people. We need to ensure these beds are used to maximum efficiency and effectiveness.
“Critical care is also often the most appropriate environment for preparation for organ donation, and there is evidence that donation is sometimes difficult to accommodate with the current capacity. It is vital to the success of our proposed opt-out system of organ donation that we have the right plan for critical care in Wales.”
Dr George Findlay, a consultant in intensive care medicine at Cardiff and Vale University Health Board and Chair of the Welsh Transplantation Advisory Group, said:
"I welcome the publication of the Delivery Plan as a positive step towards optimum use of critical care in Wales. Critical care is a finite resource so it must be used for those who need it, when they need it. It is important that, when a critical care episode is complete, patients are moved on to an environment more appropriate for their needs and rehabilitation as soon as possible.
"Critical care is not appropriate for all patients, so as clinicians we have a responsibility to have open and honest conversations with our patients about escalation of treatment, appropriateness of critical care, and end of life care."
Local Health Boards are now required to develop and publish a detailed local delivery plan to identify, monitor and evaluate action needed. They will report annually on progress and must deliver the commitments contained in the plan by 2016.
Specific actions include:
Ensuring all acute admissions to hospital receive a consultant review within 12 hours of admission to identify those for whom critical care is appropriate
Patients for whom critical care is not appropriate are discussed and agreed and offered prompt access to co-ordinated, effective and compassionate palliative and end of life care
All LHBs should use National Early Warning Scores to identify deteriorating patients so early intervention can take place
All acutely unwell patients must be screened for sepsis
All acute admissions should be assessed for the risk of developing acute kidney injury
Establishing processes to ensure all patients requiring surgery have their mortality risk calculated – those with a score of predicted mortality greater than 10% will require assessment of post operative critical care admission.