closed ICU, journey from referring to ICU until discharge to general ward .pptx

this presentation is a core & simple example to show and define the team work and responsibilities of each team to reach the final joint goal which is the best patient care.
its a re-innovation in the relation between ICU team in one side and the expert primary team and consultant in the other side.
i am declaring that this presentation is only for teaching purpose and not for direct application in the clinical practice at leat without the health care higher authority agreement.

1. C losed ICU journey: from referral to discharge C larifying Roles for the Primary Team and ICU Team P repared and presented by: Dr. Abdullah Balhamar ICU Consultant, KSMC H ead of Burn ICU Unit SB-IM, SF-ACCM, EDIC

2. Our Shared Goal

3. Agenda 01 Closed ICU Core concept 02 Journey of critically ill patient 03 Rules of ICU & primary team 04 C linical vignette 05 Conclusion and takehome massage

4. W hat is a “Cloed ICU “? T he core concept

5. The Primary team become a Vital Consult:

6. O ne Captain, Many Expert Advisors: S ynthesizing all consultant input into one unified plan>

7. Stage 1: The Pre-ICU Admission Phase

8. T he most critical phase for cllaboration P rimary team resposibilities 1- recognize and escalate: I dentifying the deteriorating patient using objective criteria (MEWS, qSOFA) ICU team responsibilities 1- respond and triage:\promptly respond to the consultation request

9. T he most critical phase for cllaboration P rimary team resposibilities 2- the ICU referral call: T his is formal handoff communication. B e prepared with: patient name, location, brief relevant history and admitting diagnosis. assessment: Why you need ICU “naw” hypotension, desaturatioon on O2 ICU team responsibilities 2- the “Acceptance” Decision: A ssess the patient’s stability and ICU needs. D ecide on admission based on ICU criteria and bed availability.

10. T he most critical phase for cllaboration P rimary team resposibilities - B ackground: C omorbidities, code status. - recommendations: W hat you are asking for? ICU team responsibilities

11. T he most critical phase for cllaboration P rimary team resposibilities - B ackground: C omorbidities, code status. - recommendations: W hat you are asking for? ICU team responsibilities

12. T he most critical phase for cllaboration P rimary team resposibilities 3- stabilize and prepare: Initiate basic resuscitation (IV access, O2, fluids) Order critical labs and imaging. Discuss/confirm code status with patient and family. ICU team responsibilities 3- guide Pre-ICU Manag e ment: P rovide immediate recoommendations for stabilization (eg. “start norepinphrine”, “preare for intubation”)

13. T he most critical phase for cllaboration P rimary team resposibilities 4- document and Communicate: W rite clear transefer note summrizing the previos information E nter a formal “trasefer to ICU order” ICU team responsibilities Prerapare for Arrival: N otify ICU nursing and respiratory therapy. S et up the room and equipment.

14. S tage 2: the ICU Stay Phase the “Partnership” T he Icu team is the primary manager and all other teams act as speciality consultats.

15. S tage 2: the ICU Stay Phase the “Partnership” ICU Team L ead daily round and formulate the plan. W rites ALL orders (medication, fluids, vents, consults) M anage organ failure (ventilation, pressors, dialysis). P rimary Epert Consultant A ttends rounds (when possible) or provide input. P rovides specific written/verbal recommendations for the ICU team to consider and enter. M anage the primary disease (eg, chemotherapy, plan for future surgery)

16. S tage 2: the ICU Stay Phase the “Partnership” ICU Team 4. C oordinates all consultnt recommendations. 5. L eads family meetings annd goal of care discussions. 6. R un 24/7 bedside care. P rimary Epert Consultant C ommunicates the long-term care plan. P articipate in family meeting to provide speciality-specific prognosis. F ollows the patients daily and is available for questions.

17. C linical vignette 1: Post-Op Patient

18. C linical vignette 2:The GI Bleeding Patient

19. C linical vignette 3: The Cnstipated Patient

20. C linical vignette 4: Glycemic Control

21. C linical vignette 5: The Patient Needing MRI

22. C linical vignette 6: Unnecessary ICU Transefer

23. C linical vignette 7: The Patient ith Delirium & Restraints

24. C linical vignette 8: The Patient with “Full” Code Status

25. C linical vignette 9: The Discharge Conductor

26. S tage 3: The Pre-ICU Discharge Phase (The “Hand Back” )

27. The Pre-ICU Discharge Phase ICU Team Responsibilities Identify Readness: Determine when the patient no longer needs ICU-level care (off pressors/vent, stable) 2. Communicare Early: N otify the primary team in advance of potential transefer (e.g. likely tomorrow) P rimary team responsibilities Re-engage Fully: P roactively start planning for ward care. 2. Accept reports: Be available to receive a direct handoff call resident/fellow.

28. The Pre-ICU Discharge Phase ICU Team Responsibilities 3. The “Handoff” Call: P rovide a succinct update: - ICU course & active issues. - Current meds and drips. - Code status P rimary team responsibilities 3. Assume Care: Write the first set of ward orders and see the patient promptly upon transefer.

29. The Pre-ICU Discharge Phase ICU Team Responsibilities 4. Ensure Stability: O ptimize the patient for transefer (e.g. wean O2, adjust pain and agitation medications) P rimary team responsibilities 4. Continous Long Term Plan: Resme management of the ppatient’s primary medical or surgical problems.

30. T he Golden Rules for Success

31. T he Golden Rules for Success

32. T he Golden Rules for Success

33. B enefits for everyone:

34. C onclusion and Key Takeaway: