Access to critical care services is defined in Guidelines for the Provision of Intensive Care Services (opens PDF, 2.77 MB). The underlying principle is a service that can provide support to a level appropriate to the complexity of patient care needs. Hospitals admitting emergency patients should have all levels of care available. All acute hospitals carrying out elective surgery must be able to provide level 2 and level 3 care if the predicted surgical mortality exceeds 10%. In certain cases, patients will need to be transferred to a different unit or hospital where more complex needs can be met (such as extracorporeal membrane oxygenation (ECMO) for very severe respiratory failure or a liver unit for acute liver failure).
Access to critical care services is from other hospital specialties or between secondary and tertiary services. Methods of referral for elective surgical admissions should follow integrated pre-operative pathways. Referrals for emergency admissions must be timely and directly involve referring and receiving consultants. Specialised intensive care services such as ECMO are commissioned according to contract specifications (opens PDF, 201.46KB) defined in national standards.