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Critical Care Patient Pathways

Critical care is an essential part of both emergency and elective pathways.

Patients may enter critical care in the following ways:

Unplanned

  • Direct presentation to emergency department with critical illness apparent at time of presentation
    Critical illness arising after hospital admission - i.e. unexpected deterioration while an inpatient, on either emergency or elective pathway.

Planned

  • Critical care as part of an interventional pathway - e.g. elective surgery where either the surgery or the co-morbidities of the patient, mean that peri-operative critical care is required.
    Some scenarios are better, in terms of length of stay and outcome, than others:

Early detection of critical illness and immediate access to critical care, is far better than delayed recognition or admission. The lay proverb "a stitch in time saves nine" has very strong clinical parallels in critical illness. Points of attention should include assurance of hospital-wide early warning and escalation systems, and that critical care resources are locally adequate to guarantee prompt access.
Similarly, unplanned critical illness arising as part of a planned hospital admission, can lead to a long length of stay and poor outcome. Where the risk of this is identified in advance and avoided through adequate planned critical care provision, outcomes and costs may be significantly improved compared to reactive, unplanned care provision.
For example, a pre-booked post-operative HDU (level 2) stay for a high-risk surgical patient, may dramatically reduce the risk of deterioration on a general ward and unplanned ICU (level 3) admission.

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