The Nepean Intensive Care Web Site

http://www.nepeanicu.org

Nepean ICU Liaison Team

The Nepean Hospital ICU staffs and coordinates the Intensive Care Liaison Service. This service seeks to improve patient care and follow-up post discharge from the ICU. This service is based on current practices that are already in place in other intensive care units across Australia and overseas that have proven results in terms of patient outcomes and readmission rates. The service involves a visit each day by a specialist intensive care nurse who will review and assess every patient that has been discharged to the general wards. The Liaison Service also provides bedside education and clinical support to the ward staff regarding patient care issues. The small team of Liaison nurses is headed by an Intensive Care Liaison Clinical Nurse Consultant who also coordinates a Central Line insertion service for the entire hospital

Role of the Liaison Service

The Liaison Service has five basic aims:

  1. to improve communication between ICU and the wards
  2. to follow up all patients discharged from intensive care
  3. to avert readmissions to ICU
  4. to provide clinical support and education to ward nurses on complex patients
  5. to facilitate early and appropriate admission / readmission to ICU

The ICU Liaison Service addresses the issues that are faced by staff on a general ward when a patient is transferred to the general ward from a highly specialised area such as an Intensive Care Unit. Not only can discharge be a stressful experience, but also it carries a risk of readmission to the intensive care unit due to preventable complications if the patient is not managed appropriately on the ward.

The ICU Liaison Service also provides bedside education and support on issues such as tracheostomy care, central lines, intercostal catheters, haemodynamic status, fluid and electrolytes imbalance and pain management. The Liaison Nurse will consult the patient and their families regarding any issues or problems they may have. In addition, the relatives and significant others will be offered the availability of an outpatient appointment if required to address any issues or concerns with a social worker or counsellor.

Background Information

Intensive care unit readmission carries a high risk of mortality and increased length of hospital stay. Studies have shown that many patients who are readmitted to the intensive care unit from the general ward are treated for a condition that could have been prevented, such as sputum retention in a tracheostomy patient.

Readmission to the Intensive Care Unit has substantial financial and resource implications as an expensive intensive care bed is used for a patient with a potentially preventable complication. In the interests of providing both an efficient use of available resources and also providing quality patient care an ICU Liaison Service was introduced to Nepean Hospital.

Research has shown that this type of service improves outcomes for patients post discharge from the intensive care unit by reducing the number of preventable readmissions and reducing the acuity of patients that are readmitted. Several studies have shown that the introduction of an ICU Liaison Service also improves the standard of patient care on the wards through the provision of clinical and educational support to the ward nurses.

Intensive Care Liaison CNC

The position of Intensive Care Liaison Clinical Nurse Consultant is one example of a nurse in the Nepean ICU who works in a role that expands previous conceptions of what a nurse should do. Working closely with the team of Liaison Nurses, the Liaison CNC has responsibilities to the Service that can be summarised in five areas:

Clinical Services Delivery and Consultancy:
The CNC coordinates the intensive care liaison team. The CNC coordinates and facilitates the management of all patients with a tracheostomy and will develop and establish a referral network for staff to access when requiring assistance with the management of a patient with a tracheostomy to ensure patient safety and the best outcome for the patient. The CNC will coordinate the Intensive Care Unit’s Central Line Service, which provides insertion of Central Venous Lines including PICC (Peripherally Inserted Central Catheters) lines to the rest of the Nepean Hospital, excluding the Emergency Department. The CNC will develop and maintain collaborative links between nursing, medical and allied health staff and the intensive care unit to provide continuity of care for patients leaving intensive care. The CNC facilitate the admission and discharge process for patients requiring Intensive Care services.
Clinical Services Planning and Management:
The CNC will initiate, facilitate and participate in quality improvement activities in clinical areas to enhance the operation and effectiveness of the intensive care liaison team. The CNC will also provide ongoing comprehensive review and analysis of the practices of the intensive care liaison team and the impact of new directions on the clinical service.
Clinical Leadership:
The CNC will provide clinical leadership and supervision to the nurses working in the intensive care liaison team. The CNC will be expected to contribute to the nursing body of knowledge with special emphasis on ICU Liaison Service Development.
Education:
The CNC will deliver education on clinical issues and practices to patients, carers and staff as well as developing an ongoing educational strategy for nursing and medical staff within Nepean Hospital regarding the intensive care liaison team. The CNC will maintain theoretical knowledge and understanding of contemporary practice through participation in professional specialty group plus ongoing education and regular attendance at professional forums (eg; conferences, seminars, courses). The CNC will create a learning culture that encourages staff involvement in service and clinical decision-making whilst in a supportive and educative environment.
Research:
The CNC will develop and research all proposed protocols, policies and procedures to ensure based on contemporary research and evidence as well as participating in the development, preparation and delivery of clinical research reviews, professional seminar and conference paper and poster presentations including the ANZICS/ACCCN. The CNC will ensure accurate and timely completion of relevant data for the intensive care liaison service, analyse and review findings to ensure best practice principles are applied. The CNC will adapt and apply relevant scientific research in liaison services and review applicability for implementation into the Intensive Care Liaison team The CNC will be expected to formulate, initiate, develop and implement nursing research projects appropriate to clinical practice in intensive care and liaison service and present finding both internally and externally to colleagues.

Contact the Liaison Team

If you would like more information concerning the Nepean Intensive Care Liaison Service or the position of Liaison Clinical Nurse Consultant please feel free to send an email to the current Liaison CNC. Alternatively the ICU can be contacted by phone: (+61) 02 47342468.