Bridging guidance for critical care during restoration of NHS services
The Faculty is pleased to announce the release of Bridging guidance for critical care during restoration of NHS services. The Faculty recognised the need to provide guidance as we move in to the next phase and the importance of initiating and managing this phase in a methodical and realistic way.
During the COVID-19 pandemic critical care has been pivotal to the NHS response. Expanding critical care capacity to a potential four times baseline identified a requirement to change the way we deliver care differently on a temporary basis. This included relaxing our normal GPICS standards in terms of staffing ratios and working as teams to welcome those with minimal, or no critical care expertise. This, along with the requirement to wear PPE for prolonged periods of time, has had a detrimental impact on staff morale and challenged ideas of patient safety. Living with COVID-19 will influence how we practice critical care both in terms of cohorting patients, working closely with colleagues in Anaesthesia and other specialties and professions, and maintenance of the team based competency approach, which worked well when we were at peak surge.
As we move to the next phase, and restore some NHS services, each organisation will be at a different place in terms of the surge capacity they utilised and how close they are to returning to baseline. It is important that critical care remains resilient to support this restoration, in terms of staff, drugs and consumables and PPE. Critical care may need to be delivered on multiple sites to avoid the risk of Hospital Acquired Infection and, unless there are increased qualified critical care staff, services will be unable to operate at normal baseline activity. GPICS standards must be restored before business returns to normal and therefore, as critical care will have demands from a variety of specialties, its capacity should be the focus of any planning strategy. In addition, we need to maintain a level of intervention based competency in our non-ICM workforce to facilitate rapid redeployment, should it be required again. Enhanced Care may present an opportunity to maintain an upskilled reserve workforce for future pandemics and other significant emergency events.
The accompanying document should be used to identify what critical care capacity each organisation has and therefore the focus needed to safely restore services. Non-urgent activity should not be undertaken where staffing levels are below GPICS standards unless a critical care service can support it safely.
Dr Alison Pittard
Dean, Faculty of Intensive Care Medicine.
This guidance is an evolving document that will need to be modified as the situation changes. It was produced in consultation with the Critical Care Leadership Forum. It has also been reviewed by the NHS Commissioning’s Adult Critical Care Clinical Reference Group.
It is endorsed by:
- Association of Chartered Physiotherapists in Respiratory Care (ACPRC)
- British Association of Critical Care Nurses (BACCN)
- British Dietetic Association (BDA)
- Critical Care National Network Nurse Leads Forum (CC3N)
- National Outreach Forum (NoRF)
- Neuro Anaesthesia & Critical Care Society (NACCS)
- NHS Blood and Transplant (NHSBT)
- Royal College of Nursing (RCN)
- Royal College of Speech & Language Therapists
- UK Clinical Pharmacy Association
And supported by:
- Prof Jane Eddleston, Chair, NHS Commissioning’s Adult Critical Care Clinical Reference Group
- Penelope Firshman on behalf of the Royal College of Occupational Therapists
- Ruth May, Chief Nursing Officer for England
- Paediatric Intensive Care Society (PICS)