ICU Exit Block Project

A whole of hospital approach to optimising intensive care capacity

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.

Evidence shows that exit block, after-hours admission and after-hours discharge from intensive care is associated with:

  • poorer patient outcomes
  • reduced ICU capacity to admit critically ill patients, with an impact on whole of hospital patient flow
  • poorer patient journey and experience
  • poorer staff experience.
  • increased costs.

Read the Evidence Review

Patient experience

Listen to a Craig describe his experience in the ICU.

Read a transcript of Craig's experience

Project design

The Agency for Clinical Innovation (ACI) is exploring strategies to reduce ICU exit block and improve ICU patient flow. The ICU Exit Block Project involves an initial pilot research study, followed by a state project delivered in two phases implemented across NSW ICUs:

  • Pilot research: March 2018 – December 2019
  • Phase 1: February 2019 – January 2020
  • Phase 2: Commences later in 2019.

Pilot research

The pilot research project phase involves Gosford, Liverpool, Nepean and Wyong Hospitals, with each pilot site establishing local project teams to design and implement strategies to suit local issues affecting exit block.

Local ICU specific solutions were designed and implemented, and are now being monitored at the four pilot sites. Sites are progressing to design and implement whole of hospital strategies to improve patient flow processes and optimise intensive care capacity. Site-based strategies will be evaluated and the applicability for state use will be determined.

State Project Phase 1

Phase 1 of the state project commenced in February 2019 and involves 10 participating sites including:

  • Bankstown
  • Blacktown
  • Campbelltown
  • Concord
  • Dubbo
  • John Hunter
  • Lismore
  • St George
  • Tamworth and
  • Wagga Wagga.

The ACI, in partnership with the Ministry of Health ‘Whole of Health’ team, will support local project teams to design and implement strategies to suit local issues effecting exit block.

To determine issues causing exit block, the teams will collect and evaluate information from various sources, including staff surveys and interviews, patient interviews and patient outcome data.

Sites will implement one ICU specific and one whole of hospital solution with an aim to reduce exit block, improve patient flow and enhance the experience for patients, carers, families and staff.

State Project Phase 2

Phase 2 of the state project will commence later in 2019 and involve up to 10 additional sites. A number of sites have already expressed an interest in participating in Phase 2. Interested sites can contact Intensive Care NSW for more information.

NSW implementation: Guiding Principles to Optimise Intensive Care

Ensuring the right care, for the right patient, in the right place

The ACI partnered with four NSW ICUs to test and implement identified solutions to reduce intensive care exit block. This partnership, together with a literature review, informed the development of the Guiding Principles to Optimise Intensive Care Capacity to assist in the reduction of ICU exit block and improve facility patient flow. The principles, which incorporate best practice, align with the Whole of Health program and with the Ministry of Health patient flow systems framework. They include nine key elements to ensure patients have access to the right care in the right place.

Review the Draft Guiding Principles to Optimise Intensive Care Capacity

The following resources are available for your use:

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 ETP
  • patient, carer and family experience
  • staff experience.

If you would like more information about the project, please contact Leesa Hawkins, Clinical Project Officer, Intensive Care NSW, at ACI-Intensive-Care-NSW@health.nsw.gov.au