Adult Extramural (ExACCRT) Process – V10 Process Objectives: Ensure Patients receive the right care at the right place at the right time Decrease access time to Specialists for referring Physicians requiring help Improve the distribution of care for ICU Patients throughout the region
May 14, 2012
ExACCRT Triggers: All life or limb cases requiring a level 3 ICU bed Direct referral to an LHSC ICU No response from receiving community Physician in 20 minutes Receiving community hospital not able to accept transfer of a Patient Refusal or no response from Subspecialty for all life or limb cases LHSC One Number requires consultation
Scenario’s: #1: Community hospital referring directly to community level 2/3 ICU for consultation and/or transfer of critically ill patient #2: Community hospital referring directly to LHSC ICU for consultation and/or transfer of critically ill patient #3: Community hospital referring directly to LHSC sub-specialty service (e.g. Neurosurgery) #4: Community hospital calls Hospital “One Number” directly and asks for direct referral to sub-specialty
Key Principles: CritiCall is the single point of contact for all Critically Ill, Life or Limb, or transfer of a nonurgent ICU Patient to another ICU Optimize critical care resources within SW Ontario CritiCall will contact all requested parties and ExACCRT Consultant (via LHSC One Number) when triggered
Definitions: Critically Ill – Patient requires care within 4 hours Life or Limb – Patient is at risk of losing a limb or life ExACCRT Consultant – Adult Extramural Consultant, that is an LHSC Intensivist
Receiving Hospital - Community Existing CritiCall Process
Y
CritiCall contacts receiving Hospital via established communication process to contact receiving Physician
Transfer required. receiving Hospital accept Pt?
Patient Transfer Process
Y
ExACCRT Consultant determines next appropriate receiving Hospital
Patient received
Receiving Physician responded w/in 10 mins?
N CritiCall contacts designated receiving Hospital Physician via established communication process
Y N
Scenario 1
N
CritiCall contacts receiving hospital to contact Physician again
N
Receiving Physician responded w/in 10 mins?
CritiCall patches in receiving Physician with rest of group
ExACCRT Consulant, referring Physician, receiving Physician & Subspecialty(if req’d) discuss case
Receiving Hospital accept Pt?
Y
Patient Transfer Process
ExACCRT Consultant Leaves call
Y
Patient Transfer Process
ExACCRT Consultant Leaves call
N
Receiving Hospital - Not Determined
LHSC One Number to get subspecialty Physician on the call (if req’d)
CritiCall to ask if Pt. is Life or Limb
Management advice provided. (Further Physician to Physician discussions may take place during Patient care).
N
N Scenario’s 1, 2 & 3 Referring Physician calls CritiCall
Scenario’s 1,2,3,4 Physician requires consultation or potential transfer of a Critically Ill, Life or Limb, or ICU Patient
Referring Physician provides Patient Information Survey & receiving request
Referring Physician hangs up to wait for call back from CritiCall
Direct referral to an ICU?
Y
Referral to LHSC (N= referral to other Hospital)
CritiCall Contacts LHSC One Number requesting ExACCRT Consultant be paged & Subspecialty (if required)
Scenario 2 Y
LHSC One Number pages ExACCRT Consultant, VH & UH Charge Nurses
Hospital One Number contacts CritiCall & patches Referring Physician to Criticall Referring Physician calls Hospital One Number
Scenario 4
Hospital One Number advises Referring Physician to call CrititCall
ExACCRT Consultant responded w/in 10 mins?
CritiCall calls back referring Physician with LHSC One Number, ExACCRT Consultant, Charge Nurses & Subspecialty(if req’d) on the line
Y
N
Y
LHSC One Number repages ExACCRT Consultant
ExACCRT Consultant responded w/in 10 mins?
ExACCRT Consultant, referring Physician & Subspecialty (If req’d) discuss case
Transfer Required?
Y
N
LHSC One Number pages ExACCRT Back-up
Transfer urgency (< 4 hrs, 4 - 24 hrs, >24 hrs), level of care (CCU, Level 2 or 3 ICU) & appropriate receiving hospital determined.
Receiving Hospital LHSC? End
ExACCRT Consultant & CritiCall determine receiving hospital outside of LHIN
N Y
N
Receiving Hospital - LHSC
LHSC One Number repages Subspecialty Physician
Scenario 3
Subspecialty Physician responded w/in 10 mins?
N
Level 3 ICU required? N
CritiCall contacts LHSC One Number to contact subspeciality Physician
LHSC One Number pages subspecialty Physician
Subspecialty Physician responded w/in 10 mins?
N
Y
Y
CritiCall calls back referring Physician with LHSC One Number and subspecialty Physician on the line
Y
Y
Designated receiving ICU Physician on-call paged via established communication process
ExACCRT Consultant & ICU physician discuss case
ICU Physician accepts Pt.?
N Referring & subspecialty Physicians discuss case
During the conversation, LHSC One Number may recommend consulting with the ExACCRT Consultant
Transfer req’d. subspecialty accept Pt?
Y
ICU bed required?
Existing CritiCall & One Number processes
N Existing CritiCall & One Number processes
ExACCRT Consultant Leaves call
End
Legend:
Terminator
Start & Stop Points
Decision
Branch in process that has two possible paths
Process Step
Activity or task
Predefined Process
Series of process flow steps that are already defined
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