Intensive care unit exit block

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A whole of hospital approach to optimising intensive care capacity - ensuring we deliver the right care, for the right patient, in the right place.

Intensive Care NSW has explored strategies to reduce ICU exit block and improve patient flow.

Resources

Guiding principles to optimise intensive care capacity (PDF 2.5 MB)
Published: October 2019. Next review: 2025.

These principles reduce ICU exit block and improve patient flow across the facility. This results in:

  • improved ICU capacity to admit critically ill patients
  • better patient outcomes
  • improved experiences for staff, patients and their families.

The principles:

  • incorporate best practice
  • align with the NSW Whole of Health program
  • Are mapped to the NSW Patient Flow Systems Framework.

Implementation tools

Background

Intensive care services are a precious resource that should be provided in a safe, efficient and consistent way. ICU exit block has been identified as a significant problem impacting the care of critically ill patients in NSW.

The ACI partnered with four sites from March 2018 to December 2019 to conduct a pilot research project. This experience and the evidence gathered was used to develop and refine the guiding principles. Between 2019 and 2020, the ACI supported other ICUs across NSW to implement the guiding principles.

Case for change

Evidence

To determine issues causing exit block, information from various sources, including staff surveys and interviews, patient interviews and patient outcome data, was collected and evaluated.

An evidence review showed that ICU exit block is associated with:

  • poorer patient outcomes
  • reduced ICU capacity to admit critically ill patients, with an impact on whole of hospital patient flow
  • increased after hours discharge from ICU which prolongs both intensive care and overall hospital length of stay
  • poorer patient journey and experience
  • poorer staff experience
  • increased costs
  • adversely affected overall hospital performance.

Read the evidence review (PDF 706.0 KB)
Published: February 2019. Next review: 2025.

Patient experience

Listen to Craig describe his experience in the ICU.

Read a transcript of Craig's experience (PDF 195.5 KB)

Objectives

Intensive Care NSW will evaluate the success of the project based on several measures, including:

  • the reduction of ICU exit block
  • the reduction of after-hours discharge from the ICU
  • the effect on other hospital patient flow performance indicators, such as emergency treatment performance
  • patient, carer and family experience
  • staff experience.

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