Analysis of critical care referrals

Introduction

Anecdotal evidence at our hospital suggested an increase in the number of patients referred for admission to the ITU by junior doctors without consultation with senior doctors from their own specialty. Recent UK guidance has recommended consultant-to-consultant referral for critical care patients [1]. Our ITU welcomes the timely referral of at-risk patients. However, excessive numbers of poor referrals have contributed to the prolonged absence of critical care team members from the unit. At a time of increasing difficulty in maintaining adequate levels of medical cover because of regulations concerning hours of work and training requirements, there is concern that this may adversely affect the efficient and safe management of the ITU.

Methods

All referrals were prospectively recorded for a 6-week period. The following data were recorded: date/time of referral, grade/specialty of the referring doctor, involvement of the referring consultant, indication for the referral, referral to assessment time, duration of the assessment and whether the referral led to admission.

Results

Fifty-seven per cent of referrals were out of working hours. The sources of the referrals were as follows: emergency codes 29% and specialty referrals 71%. The admission rates to the ITU for the referrals were cardiac arrests 33%, trauma calls 75%, specialty referrals 42%. Referral rates according to grade (excluding emergency codes): consultant 14%, senior trainee 49%, junior trainee 37%. Admission rates according to grade of referral: consultant 54.6%, senior trainee 42.1%, junior trainee 34.4%. The mean time to review of referral was 20.2 minutes. The mean time for assessment for all referrals was 38.8 minutes. This was 52.3 and 28.9 minutes for patients admitted to the ITU and not admitted, respectively. The mean assessment and management times for the code calls were: cardiac arrest 42 minutes and trauma calls 81.2 minutes.

Conclusions

Our data suggest that consultant-to-consultant referral would reduce ITU referrals that do not require admission, and decrease the time that ITU trainees are off the unit.