Box 1.

Smaller remote and rural critical care units. Reproduced with permission from The Faculty of Intensive Care Medicine, Intensive Care Society. Guidelines for the provision of intensive care services. FICM, 2019.

Network support must be in place to ensure smaller, remote and rural critical units meet these standards and recommendations.
The critical care service must be led by consultants trained in ICM.
There must be access to appropriate advice from a consultant in ICM at all times.
Dedicated daytime critical care must be provided by a consultant trained in ICM with no other commitments.
There must be a doctor or ACCP with advanced airway skills resident within the hospital 24/7.
There must be a 24/7 dedicated resident on the critical care unit.
There must be structured handover between daytime and night-time staff supported by standardised policies for practice.
Appropriate CPD must be supported by the employer and undertaken by all professionals who deliver intensive care.
Regional transport arrangements (road and air) must be put in place to allow timely, safe transfer of patients with an appropriate level of monitoring, staffing and skills.
All critical care units, including level 2 units, must enter data into national databases such as ICNARC or SICSAG.
Network support should be explicit, resourced and supported by all the healthcare organisations, boards, networks and regions involved, and recognised in job planning.
Units should consider the development of telemedicine techniques for clinical decision making and educational support, in conjunction with their regional network.
Remote critical care units should implement appropriate joint clinical governance procedures with both networked units and transfer services to include case-based review, critical incident analysis and joint educational sessions.
Where an intensive care pharmacist or healthcare professional, such as a physiotherapist or dietitian, cannot be effectively delivered locally in a small unit, advice should be accessible from specialist colleagues through network support. Appropriate training bodies should devise and support remote and rural training posts in critical care.
  • ACCP = acute critical care practitioner; CPD = continuing professional development; ICM = intensive care medicine; ICNARC = Intensive Care National Audit & Research Centre; SICSAG = Scottish Intensive Care Society Audit Group.