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CRITCON

CRITCON is designed as an easy to collect, easy to report, and easy to interpret, tool for ICU capacity under conditions of system stress (e.g. winter, pandemic, or major incident).

CRITCON - example dated 2013-14

  • CRITCON is declared by units and can be posted on to the Capacity Management System (CMS) website in use in London.

History

  • CRITCON was initially designed within NW London Critical Care Network in 2009 in response to the H1N1(2009) influenza pandemic and the potential threat of triage by resource (critical care rationing). It was discussed and adopted by the London H1N1 Pandemic Planning Group on behalf of NHS London, and subsequently by several SHAs in England during the 2009 pandemic.
  • CRITCON was adapted for Winter 2010 and currently remains in modified use in London, following further review by the NHS London Critical Care Steering Group.

Principles

  • The principle behind CRITCON is to allow each unit to declare itself in simple terms compared to its normal capacity (CRITCON 0-4, corresponding to 'business as usual', 'normal winter', 'unprecedented', 'last resort', and 'triage'). This enables units under unusual stress to be instantly visible and to trigger mutual aid, for example through neighbouring units stopping elective activity or opening reserve beds.
  • Under low to medium stress conditions (e.g. a 'bad winter'), CRITCON serves as a low-workload reporting tool that minimises reporting burden and is easy to interpret as it does not need detailed knowledge of each unit's bed numbers.
  • In extreme scenarios, CRITCON is designed to ensure that no unit reaches triage conditions (CRITCON 4), and thus no patient should be denied critical care through rationing, until all possible mutual aid has been triggered, and every other unit in the region and the country is at CRITCON 3 i.e. maximum physical capacity including all expansion areas in use.

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