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Dr Gary Masterson, President of the Society, reflects on the current winter pressures facing those working and being treated in intensive care and high dependency units.

I’ve just completed a week covering my ITU and I suspect that many of you have or are currently experiencing the same sort of chaos I have just endured. There’s no doubt that this winter is intensely busy for us and the NHS in general. Many hospitals are log jammed with sick patients from the front door (ED), through the wards, including critical care, to our discharge lounges. This makes it difficult for all the nurses, AHPs, consultants and trainees working on our units.

My frequent walks into ED in the last week have been really quite alarming; trolleys occupied by the elderly, frail people everywhere and tired and distressed relatives looking desperate. Feedback from colleagues throughout the NHS suggest that my description of things applies across the system. NHSE has been pro-active in announcing the acceptability of early cancellation of non-urgent surgery to free up up both critical care, and general hospital capacity. Despite colleagues’ perhaps deliberate misinterpretation of the meaning of the word “urgent” when deciding whether to postpone electives, this announcement has helped in relieving the pressure to some extent.

“We have received more referrals than usual. This, in addition to reflecting our medical and surgical colleagues’ desperation out there, is a measure of patients’ high severity of illness.”


We have received more referrals than usual. This, in addition to reflecting our medical and surgical colleagues’ desperation out there, is a measure of patients’ high severity of illness. We all do our best not to allow our very tight bed status to influence our critical care admission decision making, but, if I’m honest, I’m not sure I’m perfect in this regard. Despite the best of intentions there’s no doubt in my mind that the current bed pressures do make me think considerably harder about admitting patients.

Cast your mind back to the Winter of 2010-11 and the H1N1 crisis. Nightmare! There weren’t any formal national escalation plans in place. The critical care networks which existed at the time did their best to help manage the crisis with varying levels of success. National bodies provided little guidance or support. Today, although the situation is grim and likely to become more so, we are in a better place. National and local escalation plans have been developed with strong clinical input following the H1N1 experience 7 years ago. Critical Care Operational Delivery Networks are now established throughout most of the UK to help operationalise these plans. I’m not suggesting that things are good at the moment but they are certainly better than they used to be.

Influenza is certainly contributing to critical care bed pressures and general hospital activity at the moment. Although the numbers are not massive yet, the trend is moving in the wrong direction as this chart from NHSE’s weekly surveillance data shows (1).

 

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This could well be the catalyst for further crisis and the need to invoke formal NHSE escalation plans. Of course I am hoping this doesn’t happen, but my instinct is that we have a difficult month or two in front of us. I hope I’m wrong here. It wouldn’t be the first time. We’ll see.

“..my instinct is that we have a difficult month or two in front of us “

The Intensive Care Society is here to help and support you through difficult times. It is the UK’s multi-professional home of critical care. Tell us how things are on your units (positive and negative stories).  We understand that winter pressures affect all staff and we want to hear how from nurses, AHPs, consultants and trainees. Do this by reply to this blog using the facility below (“Leave a comment”) and/or use our social media channels. We will do our best to ensure that your voice is heard widely. We all know that numbers don’t always tell the full story. We are in this together.

1)https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/673200/Weekly_national_influenza_report_week_02_2018.pdf

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