Stay, just a little bit longer…

AK

Ausva~an Crmcal Care

Editoriul "Stay, ] . s t . little bit lo.ger..." G a v i n D Leslie

Editor,Australian Critical Care

As damands on tha health systam continue to grove, particularly in tha public sactor, tha managamant of patiant throughputs in intansiva tara bacomas incraasingly dimcult Whilst traditional approachas which raliad on sumciant bad and staff availability

References 1

TmogRD, Brock DW, Cook DJ, Danis M, Lute JM, Rube+deldOD & Levy MM Rationing in file inenslve care unit Critical Care Medicine 2096; 34:958-963

2

OoldfradC & Rowan K Consequencesof dischatgesfrom intensive ca> at night Lancet 2030; 355:1138-1142

3

Williams YW & Leslie GD Delayed dischatges from an adult intensive care unit Austtohan Heals Review 2004, 28(1):87-96

couplad to an ordarad surgical admission list hava long passad, clinical staff now feca tha dilamma of who most naads tha i nta nsiva tara bad and what ara tha consaquancas for thosa who hava baan or might ba daniad accass This procass of admission and discharga from [CU ralias on a complax combination of 'gatakaaping' dacisions and bast outcoma banafits which in turn ralias on a combination of oblactiva assassmant and sublactiva knowladga of individual patiants, tha tara at tha discharga dastination and tha altarnativas for patiants not offerad admission 1

Editor's note This is tha last adition of Austrd~n Crlti~[ Co,e to ba publishad by tha Cambridga Madia Group out of Parth, We starn Australia Tha journal has hald a long association with this group, first as [nkprass

Ona racant featura of discussion in [CU circlas is tha feta of tha altar hours discharga, a groveit,g phanoma non giva n tha damand for amargancy admissions and lack of availabla bads within intansiva

Intarnational than mora racantly as Cambridga Madia We hava sharad a sustainad pariod of growth and innovation as

care 2 Traditional practica in mat,y Australian [CUs save a passlva avoidanca of transfer of patiants out of tha ICU outsida of usual

a publication ovar this tima and, as aditor for tha last • yaars,

businass hours Arrat,gamants wara mada to "kaap tham in until tha next day" or "for tha waakand" ~ Whilst this seeming l ~ u r y

particular Grag Paull and Caridwan Clocharty, for thair anthusiasm

might hava been considered axtravagant by a manager matching best usa of resources to demands, amarging evidence in Australia and established reports from overseas, particularly tha UK, highlight tha risks associatad with unplannad discharga of patiants from [CU into tha hospital ward altar hours, both at night and waakands This craatas an intarasting dilamma for clinicians making discharga dacisions thay know that sanding a patiant out of [CU to ward araas which ara staffed and run on a traditional menial of tara which

I parsonally wish to thank all tha staff of Cambridga Madia, in and driva in gatting us to tha post four timas a yaar They hava in later years also produced C,~ti~[ Trees which has providad ACCCN mambars with a timaly up:lata of activitias on a Stata and national laval in critical tara nursing in Australia A haartfelt thanks to you all on bahalf of tha FaJitorial Board, ACCCN and all our raadars and supportars

limits any intat~antion and assassmant of patiants during tha aftar hours pariod could haightan thair risk of axpariancing an advarsa avant If rasourcas ara unabla to ba incraasad in tarms of ICU bads, than a systam which accommo:latas thosa laavmg ICU with ongoing tara managamant issuas and hastily praparad discharga plans naads to ba davisad Numerous strategies hava been proposed for managing this problem, including [CU stap-down walds, [CU liaison nurses and [CU outreach teams Tha affectivanass of these approaches is yat to ba fully established Howavar, given wa know that after hours discharge seems now to ba a predictor of risk for [CU patients, wa need to have a process in systam for aliminating, or at least raducing, that risk

Gavin D Leslie, Edlt~

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