1. Co-dependencies for critical care patients Mansoor Sange Darent Valley Hospital, Dartford South East Coast Clinical Senate Defining the clinical co-dependencies of acute hospital services 10th September 2014

2. Task To identify what services are essential for the safe provision of critical care services Do these services need to be co-located with the critical care unit or can they be provided on a network basis? I understand that this is different “what services require a critical care unit to support them?” The difference is probably not always useful.

3. My Approach Try to understand the question asked Identify the sources of help / evidence. Read, read, read. Collate the useful bits. Discuss with medical and nursing colleagues from Kent, Surrey and Sussex Identify the tricky issues Hope to achieve consensus.

4. Evidence base Systematic search kindly provided by Tom Roper Identified a few papers. Useful in identifying the specialities that need critical care but not the other way round. Included

6. Evidence base A very Un-systematic search

8. Guidelines

10. Expert Opinion Discussion with medical and nursing colleagues from Kent Surrey and Sussex. Examples of services in the KSS area that were working well.

11. Red Tags Acute General Medicine Elderly Medicine Respiratory Medicine Gastroenterology (and urgent endoscopy) Diabetes and endocrinology Gynaecology General Surgery (upper GI and lower GI) Trauma Orthopaedics Urology ENT General Anaesthetics Inpatient nephrology Acute oncology Palliative care Neurology Diagnostic radiology / CT Scan Interventional radiology (including neuro-IR) microbiology, Urgent diagnostic Haematology and Biochemistry Transfusion, and Blood Bank Acute in patient Rehabilitation Physiotherapy / Speech and language / Dietetics Acute mental health services

12. Red Tags Acute General Medicine Elderly Medicine Respiratory Medicine Gastroenterology (and urgent endoscopy) Diabetes and endocrinology Gynaecology General Surgery (upper GI and lower GI) Trauma Orthopaedics Urology ENT General Anaesthetics Inpatient nephrology Acute oncology Palliative care Neurology Diagnostic radiology / CT Scan Interventional radiology (including neuro-IR) microbiology, Urgent diagnostic Haematology and Biochemistry Transfusion, and Blood Bank Acute in patient Rehabilitation Physiotherapy / Speech and language / Dietetics Acute mental health services

13. Amber Tags Rheumatology Dermatology Maxillo-facial surgery Hub vascular surgery Spoke vascular surgery Neurosurgery Plastic surgery Burns Inpatient dialysis MRI Scan Cardiac MRI Occupational Therapy

14. Green Tags A&E /Emergency Medicine Paediatrics Paediatric surgery Neonatology Nuclear Medicine

15. Tricky areas Urology ENT Acute oncology Interventional radiology (including neuro-IR) MRI Scan A&E /Emergency Medicine Others……?

16. Summary Very little evidence found Expert opinion Open to discussion