Intensive Care Service Model

Intensive care services are a precious and costly resource, which need to be consistently, safely and efficiently provided. The Intensive Care Service Model provides recommended standards for the safe and efficient delivery of care in Level 4 ICUs, to improve the care of the critically ill patient. Implementation of the Intensive Care Service Model across NSW will improve delivery of intensive care services and the care of the critically ill patient in rural, remote and metropolitan hospitals.

Networked LHD Intensive Care Services: Framework to support standardised service delivery, care provision that includes an integrated LHD Intensive Care Service that is consistent across NSW. Units are networked with a higher care unit within LHD or across a region.

Units operate as a closed collaborative model; these are defined as overarching medical governance and leadership being in place (gatekeeper role) -75% now open.

Patient care is delivered and coordinated by the specialist responsible for the unit in collaboration with the admitting consultant like in the level 5/6 ICUs across NSW.

24/7 medical presence in units, in hours Mon-Fri ICU Specialist, after hours medical officer primary responsibility for ICU but to also support other functions within hospital. There will be access to senior clinical advice (after hours through either oncall or telehealth support from networked unit).

Standardisation of processes across LHD where appropriate (i.e. policy, procedures, education, professional pathways).

Patients where appropriate will have access to Intensive Care Services close to where they live.

The standards incorporate core principles of best practice service models, aligned with the CEC “In Safe Hands” functions. The recommended standards include the following. Core principles: Leadership and governance, Care planning, coordination & delivery, Standard protocol and procedures, Patient safety & experience, quality outcomes & data, Education, training & supervision, Workforce management & support services, Equipment

Implementation of the Service Model

Implementation of the service model has taken a flexible and tailored approach to ensure sustainability at the sites. The approach has supported the service redesign at each facility, including the following steps.

  1. Identification of gaps between the recommended standards and current practice by undertaking the structured self-assessment.
  2. Review the outcomes of the findings and undertake further diagnostic activities (e.g. IIMS, retrieval and service activity data, patient and staff surveys, complaints, process mapping and review) as required to better understand local issues and prioritise these as appropriate.
  3. Identify and develop solutions for gaps and service deficiencies including: assess the magnitude of the solutions (including what is in and out of scope); assessment of resources required (if any); timeframe required to fully implement the service model; potential risks / challenges to implement and how these maybe managed.
  4. Develop an implementation plan for each solution identified.
  5. Implement sustainable change through: communication; evaluation; ongoing monitoring of service delivery under the new service model and reinforcement of outcomes; sharing achievements, innovations and new processes with key stakeholders.

In this video, staff in NSW ICUs talk about their experiences implementing the model.

Benefits and outcomes

There is still work being undertake across the system to achieve the intended benefits for patients, carers and families, staff and system. Expected benefits of implementing the Service Model include the following.

  • Improved quality and safety of care delivered to the critically ill patient
  • Improved coordination of care
  • Reduce  unplanned admissions, length of stay and transfers, improved patient and their families experience and journey(supported by evidence that shows ICU’s lead by intensivists have reduced mortality rates)
  • Patients will have access to ICS close to where they live/improve patient experience

  • Improve support of staff in the delivery of care to critically ill patients
  • Improve access to 24/7 senior critical care advice
  • Improve access critical care to resources across the LHD
  • Improved staff experience

  • A networked approach rather than a unit approach to the delivery of Intensive Care Services and use of LHD Intensive Care Resources
  • Reduce unplanned admissions, length of stay, transfers and retrievals translate into better coordinated patient care
  • Enhance the critical care functions across the LHD, improving support of inpatient surgical and medical activity

The broader NSW health system

  • Standardised delivery of intensive care services in rural, remote and metropolitan NSW hospitals
  • Strengthen and sustain the functions required to support the inpatient critical care needs of NSW

Reduce in unplanned admissions, length of stay, transfers and retrievals translating into better coordinated patient care and significant cost savings to NSW Health.

Implementation resources

An independent evaluation of the ICSM implementation outcomes and the implementation process undertaken is currently underway.