SMASAC HDU Bed Report Scottish Intensive Care Society Audit Group 9 November 2007 Dr Frances Elliot

Remit To review the provision of adult High Dependency Unit (HDU) beds in Scotland and to make recommendations to the Chief Medical Officer.

HDU Definition Care appropriate for patients needing support for a single failing organ, but excluding those needing advanced respiratory support; who can benefit from more detailed observation than can be safely provided on a general ward; who no longer need intensive care, but are not yet well enough to be returned to a general ward; or who, after an operation, need close monitoring for longer than a few hours, ie the period normally spent in the recovery area. This is also referred to as Level 2 care. Definition based on that in Better Critical Care (2000).

Aim of Report To review the provision of beds, including the provision of staff and equipment to support them, to allow an accurate picture of how many beds/units there are currently in Scotland. To make recommendations to the Chief Medical Officer on: –Future provision; –Leadership; –The use of a common descriptor for HDU Beds and Units; and –A national minimum dataset.

Our task To review Criteria for admission and discharge Staffing levels –Medical –Nursing –Pharmacy, AHP and healthcare scientists Patient safety

Definitions and data sources  there is great variation in the number of HDU beds in hospitals around Scotland, which is greater than can be explained by hospital size or activity; there is great inconsistency with regard to the management and naming of beds/units; and some beds regarded as HDU beds by clinicians are not officially recognised as such and therefore may not be adequately resourced.

Patient safety Leadership National patient scoring system Access and availability of equipment Education and training

Recommendations To deliver effective care hospitals receiving acute admissions should have appropriate high dependency provision. All NHS Boards should undertake an assessment of need using the data collection form in the report. NHS QIS should look for evidence that this has been done and acted upon. The Chairs of the Critical Care Delivery Groups and the SICS should be asked to undertake this task.

Recommendations Ideally in all but the smallest hospitals there should be a dedicated HDU while the larger hospitals should aim for dedicated consultant involvement in a ‘closed’ model with inter- speciality cooperation. In consultation with the multi-disciplinary team every HDU should ensure the availability of documented criteria for admission and discharge referenced to existing guidance.

Recommendations The Definitions Support Team of the Data Intelligence Group (DIG) should be asked to develop (with clinical advice) an agreed definition of adult HDU facilities. The National Clinical Dataset Development Programme (NCDDP) should be asked to support clinicians in developing a national dataset for adult HDU. All HDUs should be included in SICSAG, which should implement the national dataset above.