Critical Care

Background

Critical care is the care provided to patients who require intensive monitoring and / or the support of failing organs. These patients are found throughout the hospital, many in general wards, but also in other dedicated areas. Intensive Care Units (ICUs) care for very ill patients who can benefit from more detailed observation or treatment than can safely be provided on an ordinary ward. High Dependency Units (HDUs) provide an intermediate level of care between ICUs and ordinary wards. Specialist areas such as renal units or coronary care units may also provide support for the critically ill. The need for critical care can arise as a result of trauma, disease, adverse events or surgery.
 
The Welsh Assembly Government is committed to improving critical care services in Wales to ensure that patients with the most need have ready access to critical care and that they are transferred on at the most appropriate time in their care to maximise effectiveness of their treatment.

The key aims are to:
  • provide high quality critical care
  • ensure patients with the most need have ready access to critical care services
  • improved efficiency and effectiveness of adult critical care services by modernising and standardising practice
  • reduce the delayed transfers of care from critical care units in order to improve patient flow and patient safety thus ensuring patients would be cared for in the most appropriate clinical environment
  • reinvest any saving into the development of critical care services

 

Policy Context

In March 2006 the Welsh Assembly Government launched "Designed for Life: Quality Requirements for Adult Critical Care in Wales". This document sets the standards that critical care units are expected to meet by April 2008, April 2011 and April 2015.

The Second Strategic Framework 2008 - 2011 directs and guides activity across Wales over the next three years to achieve the Quality Requirements for Adult Critical Care.

The Welsh Guidelines for the transfer of the critically ill adult provides a tool for the NHS and associated agencies giving comprehensive guidance and providing an all Wales standard for procedures involved in the process of the transfer of critically ill adults.

The Caring for Critically Ill Children - Standards booklet sets out the Welsh Assembly Government’s standards for caring for critically ill children.

Service Planning

Critical Care Networks were established in 2007 to work together to plan and promote the highest quality critical care services within their regions. 

The letter from the Director General Health & Social Services and Chief Executive NHS Wales dated 25 June 2010 confirmed future arrangements for the networks.

 

Service Delivery

The Health Boards have statutory responsibility for delivering services to meet the health needs of the resident population in their areas.

In North Wales, children and young people receive intensive care in Alder Hey children's hospital. In South Wales, children and young people receive intensive care in the University Hospital of Wales, Cardiff.


In both North and South Wales, a retrieval service is provided by the 2 centres where very ill children and young people are collected from the referring hospital by an intensive care transport team. 

 

Programmes/Initiatives

The Welsh Critical Care Improvement Programme (WCCIP) is funded by the Welsh Assembly through the National Leadership and Innovations Agency (NLIAH), and has enabled Intensive Care Units (ICUs) to work together to improve the quality of care for the critically ill in Wales.
1000 Lives Plus offers ongoing support to organisations who are implementing NICE Guidance (50) on acutely ill patients in hospital.

Building upon the achievements of the Safer Patients Initiative, the Health Foundation's Safer Patients Network supports leading acute trusts to continue testing and developing ways to make care safer.

 

Publications

The NICE clinical guidelines below describe how patients in acute hospitals should be monitored to help identify those whose health becomes worse and how they should be cared for if this happens and what should happen before someone with a head injury reaches hospital, who should go to hospital, the checks and tests that should be carried out and the action that should be taken once the test results are known.

The 1000 Lives Plus guide has been produced to enable healthcare organisations and their teams to successfully implement a series of interventions to improve the safety and quality of care that their patients receive.

The surveillance of central venous catheter (CVC) related infections became mandatory in Wales on the 1st September 2007. The purpose of the surveillance in the early years of data collection is to provide an initial baseline infection rate to assist NHS organisations in monitoring both their system of data collection and to aid with reducing infection over time.

Other Resources

A care bundle is a group of clinically proven interventions related to a disease process that, when implemented together, result in better outcomes than when implemented individually. The Map of Medicine has been selected as a clinical pathways tool to help healthcare professionals plan the best possible treatment programmes for Welsh patients.

The Intensive Care National Audit and Research Centre (ICNARC) is a sister organisation of the Intensive Care Society (ICS) the professional organisation for doctors working in critical care. ICNARC's aim is to foster improvements in the organisation and practice of critical care (intensive and high dependency care) in the UK.

 

Statistics/Data

A significant concern to services is the number of patients whose discharge to the ward is delayed due to lack of ward bed. This means that patients remain in a critical care bed unnecessarily and not only are critical care beds the most expensive resource within a hospital but more importantly delay presents a clinical risk to patients and reduces the ability of the service to admit other more seriously ill patients.
 
The latest statistics on Delayed Transfers of Care produced by the Welsh Assembly Government were released on 19 October 2010 according to the arrangements approved by the UK Statistics Authority.

The Critical Care Minimum Dataset is considered the minimum dataset that organisations (whether NHS or Independent) should use to collect consistent, unified information for benchmarking and quality assurance purposes. It is designed to provide a standard data framework for critical care clinical networks and providers of critical care services to use for local clinical or quality audit arrangements.