Intensive Care Service Model NSW Level 4 Adult Intensive Care Units

1. Central Coast Intensive Care Service Model
Following redevelopment of Wyong Hospital in early 2009, a Level 3 Intensive Care Unit with six operational
high dependency beds was established. Initially four beds were opened within the Gosford ICU to facilitate
staff training and education, develop network linkages and standardised processes and practices across the
Central Coast Intensive Care Service. In late 2009, these beds were transferred to Wyong Hospital and an
additional two beds opened, making a total of 6 beds.
Establishment of the Wyong Model involved:
• development of Central Coast Intensive Care Service, incorporating clinical governance processes
• coordinated delivery of Central Coast Intensive Care Service(including a Level 5 Intensive Care Unit at
Gosford and a Level 3 Intensive Care at Wyong)
• provision of onsite intensive care specialist in hours Monday to Friday, with after-hours intensive care
specialist telephone support
• provision of 24 hour designated onsite medical officer
• establishment of daily ward rounds, documented management and escalation plans in the event of clinical
deterioration
• standardised policies, procedures and guidelines
• formal medical and nursing orientation
• establishment of a nursing network, professional and accreditation pathways and education programs
• networked service planning, review of quality and safety activities including IIMS review and morbidity
and mortality meetings.
• contribute to Australian New Zealand Intensive Care(ANZICS) CORE registry.
Establishment of this model has increased Wyong Hospital service capabilities, to provide higher acuity care to
patients and undertake more complex procedures and surgery at Wyong site. It has also led to a reduction in
admissions and retrievals from Wyong to Gosford Intensive Care, increasing intensive care capacity in the higher
level unit. In the first year of implementation, there was a 50% reduction in retrievals from Wyong to Gosford
Intensive Care. In addition, the model has enabled the reverse flow of patients not requiring a higher level of
care from the Level 5 ICU at Gosford, to the Level 3 ICU at Wyong. 61
Analysis of Standardised Mortality Rates (SMR) observed a high proportion of Wyong ICU admissions have a
treatment limitation order. The unit admits a high number of patients for COPD and bacterial pneumonia,
which are both associated with an increased incidence of treatment of limitation orders across the admitted
patient data set. Patients requiring end of life care were able to receive treatment closer to where they lived.
Intensive Care Service Network – Intensive Care Service Model: NSW Level 4 Adult Intensive Care Units Page 17