/policies/,/policies/clinical/,/policies/clinical/uw-health-clinical/,/policies/clinical/uw-health-clinical/gen-care/,/policies/clinical/uw-health-clinical/gen-care/admission-discharge-transfer/,

/policies/clinical/uw-health-clinical/gen-care/admission-discharge-transfer/2124.policy

201706152

page

100

UWHC,UWMF,

Policies,Clinical,UW Health Clinical,General Care and Procedures,Admission, Discharge, Transfer

Admission and Discharge Criteria for ICU Status at The American Center (2.1.24)

Admission and Discharge Criteria for ICU Status at The American Center (2.1.24) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Admission, Discharge, Transfer

2.1.24


UW HEALTH CLINICAL POLICY 1
Policy Title: Admission and Discharge Criteria for ICU Status at The American Center
Policy Number: 2.1.24
Category: UW Health
Type: Inpatient
Effective Date: May 26, 2017

I. PURPOSE

To ensure appropriate use of the Intensive Care Unit (ICU) at The American Center (TAC) and to outline
guidelines for admission and discharge of patients to and from the ICU at TAC.

II. POLICY ELEMENTS

A. The ICU at TAC predominantly serves critically ill, adult patients who have undergone a same-admission
surgical procedure at TAC. The patient in ICU status demonstrates actual or potential acute or chronic life-
threatening symptoms and/or injury, with a potential for recovery. These patients require frequent or
constant nursing observation and nursing intervention, with active or stand-by life support systems,
sophisticated monitoring equipment, and support services. Typical ICU patient populations at TAC may
include:
i. Hemodynamic status requiring continuous assessment for critical blood loss or fluid shifts from the
vascular space and/or replacement with blood or blood products.
ii. Respiratory status requiring assisted mechanical ventilation or respiratory support by a secured
airway.
iii. Circulatory status requiring addition of a single vasoactive drug infusion with titration (with the
exception of Nesiritide, Epoprostenol, Treprostinil, Alteplase, and Eptifibatide).

III. PROCEDURE

A. Admission Criteria and Procedure:
i. Admission to the ICU at TAC is at the discretion of the eICU attending physician.
ii. Patients may be admitted to the ICU via the following mechanisms:
a. Transfer from TAC Operating Room (OR) or Post Anesthesia Care Unit (PACU).
b. Transfer from The Overnight Care Unit post-surgical procedure.
iii. Patients who meet admission criteria for the ICU will be admitted upon request of the operating
attending physician or designee by contacting the eICU attending physician and Care Team Leader
on Overnight Care. Bed availability must be determined prior to admission. In the event that patient
volume exceeds capacity, the eICU attending physician and the Care Team Leader on Overnight
Care will work with the Access Center at University Hospital (UH) to determine bed availability at
other locations within UW Health or like facility.
iv. Admission to ICU status at TAC will be determined upon availability of anticipated resources and or
consultations.
v. Length of stay in ICU status is pre-determined to be approximately 36 hours or less, but based on
patient status can be longer if TAC is able to provide appropriate support, and patient is
progressing towards a lower level of care.
B. Process for Admission to the ICU at TAC:
i. Patients will be admitted to the eICU and remain on the surgical service with primary management
by the eICU attending.
ii. Attending surgeon or designee writes postoperative ICU admission orders; anesthesia to write
orders for ventilator management in collaboration with the eICU attending.
iii. Patient will remain in PACU post procedure until the second critical care Registered Nurse (RN)
arrives at TAC.
iv. The surgical service provides bedside evaluation upon request within 30 minutes. The eICU
physician will provide critical care management. TAC in-house Hospitalists will be available for
general internal medicine assistance in collaboration with the eICU attending.
v. The primary surgical service will round daily on the ICU patient.
vi. The surgeon or designee will be available to answer questions from the family on the patient’s
course in the ICU and for the ICU stay.
vii. Upon admission, the attending Anesthesiologist as well as the attending surgeon or surgical
resident will consult with and verbally sign out to the eICU attending via a conference call through
the Access Center.



UW HEALTH CLINICAL POLICY 2
Policy Title: Click to enter text
Policy Number: 2.1.24

C. Intubated Patients:
i. If a patient is intubated the Anesthesiologist will complete an airway hand-off to the Emergency
Department physician, Respiratory Therapy, Nursing, and the eICU attending physician.
Communication with the eICU attending physician will be considered a hand-off of care. The
Emergency Department physician will be on call for endotracheal tube emergencies.
ii. If the patient was a difficult airway and/or intubation, an Anesthesiologist will remain at The
American Center (TAC).
iii. Ventilator management will be overseen by on-site Respiratory Therapy at TAC in conjunction with
the eICU attending physician.
D. Resources Required for Admission to the Intensive Care Unit (ICU):
i. Surgical service attending to serve as Attending of Record.
ii. eICU attending physician and eICU critical care nurses.
iii. Anesthesia (ED physician will intubate after-hours).
iv. In-house Respiratory Therapy
v. Two Critical Care Nurses.
vi. TAC Emergency Department physician available for emergent bedside evaluation
vii. TAC Hospitalist
viii. A member of the patient’s surgical team (physician or Advanced Practice Provider).
E. Transfer Criteria for Transfer Out of the ICU: In general, the following transfer criteria should be met:
i. Resolution of the underlying problem(s) which necessitated admission to the ICU; frequent
monitoring and management are no longer required. This implies that cardiovascular, pulmonary,
and central nervous system functions have stabilized and can be monitored and managed with the
capabilities available in an Intermediate Care (IMC) or General Care status bed on the Overnight
Care Unit.
ii. Reduction of the acuity of the underlying problem(s) which necessitated admission, such that the
monitoring and management available in an IMC or General Care status bed is sufficient for the
proper care of the patient.
F. Transfer Process for Transfer Out of the ICU:
i. The decision for transfer from ICU status to General Care or IMC status at TAC will be made jointly
by the staff physicians and members of the interdisciplinary team. Attempts should be made to
identify transfers from the ICU early in the day to facilitate subsequent admissions to ICU level of
care. When disagreements about the suitability for discharge occur, the eICU attending physician
will be consulted to negotiate a solution, with ultimate authority residing with the eICU attending
physician, Nursing, and other members of the interdisciplinary team.
ii. Order reconciliation, a change in patient status order, and a transfer note must be documented by
the primary service prior to the actual change in status. In the case of patients being managed by
and retained by the same medical team, the usual progress note for that day will suffice.
iii. When patients are ready to be transferred to a lower level of care, the ICU Registered Nurse (RN)
will coordinate with the Care Team Leader on the Overnight Care Unit to agree upon a transfer
time and room number.
iv. The receiving RN on the Overnight Care Unit will be contacted prior to transfer and arrangements
made for transfer of care for the patient. An SBAR handoff report will be given to the receiving RN
in person by the transferring RN caring for the patient. If necessary, an RN will accompany the
patient upon transfer. If continuous telemetry is ordered, the patient will be transferred with a
portable monitor and accompanied by an RN.
v. In the event a patient is transferred from the ICU at TAC to University Hospital or like facility,
transfer guidelines and processes outlined in the transfer playbooks will be followed.
G. Transfer Criteria to a Higher Level of Care
i. Patient will be transferred to University Hospital or like facility if the patient has been in the ICU for
greater than 36 hours and the patient is not progressing towards a lower level of care or TAC is not
able to provide required services or consultations. This will remain at the discretion of the eICU
attending physician.
H. ICU Discharge Criteria:
i. When discharge to home from the ICU is appropriate, the discharge will be completed according to
UW Health clinical policy #2.1.25, Discharge Planning Process.

IV. CONFLICT RESOLUTION




UW HEALTH CLINICAL POLICY 3
Policy Title: Click to enter text
Policy Number: 2.1.24

A. Conflicts which arise regarding the admission and discharge of patients from the ICU at TAC and priorities
which cannot be adequately resolved by the parties involved should be promptly referred to the Nurse
Manager and/or the eICU attending physician.

V. COORDINATION

Author: Director, Professional Services and Director, Overnight Care at The American Center
Senior Management Sponsor: SVP/Chief Nurse Executive
Reviewers: Medical Director, Critical Care Service at The American Center
Approval committees: Critical Care Coordinating Committee, UW Health Clinical Policy Committee, Medical
Board
UW Health Clinical Policy Committee Approval: April 17, 2017

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VI. APPROVAL

Peter Newcomer, MD
Chief Clinical Officer

J.Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VII. REFERENCES

UW Health clinical policy #2.1.25, Discharge Planning Process
UW Health clinical policy #2.1.3, Admission and Discharge of Patients to and from the Medical Cardiology
Intermediate Care Unit (IMC)
UW Health clinical policy #2.1.10, Inter-hospital Transfer/Direct Admissions to University Hospital/AFCH
Inpatient Units
UWHC policy #7.45, Triage of Critically Ill Patients

REVIEW DETAILS

Version: Original
Last Full Review: May 26, 2017
Next Revision Due: May 2020