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.
| Standards |
| 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. |
| Recommendations |
| 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.