Thursday, 14 November 2013

A new role for the ICU in out-of-hours care

Overnight medical staffing of acute hospitals is difficult. Australia and the UK have witnessed an evolution in the blend of resident personnel at night.  Both countries now have overstretched and failing Out-of-Hours (OOH) systems and there is widespread anxiety in the UK that the current experience is not a happy one.

The failings have been identified as a lack of qualified ICU consultants and an oversupply of under supervised junior doctors.

These junior doctors are expected to prioritise clinical and non-clinical duties effectively and work co-operatively while managing patients across a range of specialties. This in turn has led to a reluctance of junior doctors to contact the on call specialists, resulting in an overly self-reliant culture when it comes to decision making.

Dr Dashiell Gantner,  together with colleagues at The Alfred discuss the importance of the Alfred Hospital’s unique solution to this dilemma, that of the Hospital Clinical Lead (HCL) team, in an editorial just published in The Intensive Care Society (Vol 14; No. 4; pp 284-287).

The HCL is a resident senior trainee, typically a post-fellowship doctor in intensive care medicine (ICM), often dual certified with medicine or anaesthesia. ICM specialists are ideally suited to this role; they are experts in the management of acute medical problems and have ample experience in resource allocation, time management and decision making. Their role as a HCL is to act as an initial point of contact, to provide leadership and strategic direction to the junior doctors, allowing them to focus on their clinical work.

This new system, while not a possibility for all hospitals, has the potential to revolutionise the delivery of OOH care. 

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