We have >1100 level 3 admissions per annum and we have > 95% bed occupancy, therefore the ICU tends to be full most of the time and there is a lot of pressure on the beds.  All admissions must be accepted via the consultant in charge of the ICU for that day and should be coordinated through the person holding bleep 1113.  The senior nurse in charge must also be informed as they will update you on the bed status and also help to discharge patients to the ward to facilitate emergency admissions.  All admissions to ACCU should also involve a senior member of the referring team, ideally consultant.

During the day HDU referrals should go through the ACCU Team C Consultant or trainee, however, overnight all referrals/admissions come through the senior ICU trainee. Please ensure that all admissions are discussed with the ICU consultant on call overnight. If you feel ICU/HDU admission is not in the patient’s best interests then this should also be discussed with the ICU consultant on call.  Even if the patient’s physiology is stable and they do not immediately require organ support, bear in mind injury burden and likely evolution over the next 24-48 hours.

There is an electronic booking system for elective admissions to ACCU, both ICU and HDU but bed availability needs to be re-confirmed with ACCU staff on the day of surgery. The consultant and the nurse in charge normally co-ordinate this via the ACCU bed manager.

All ACCU patients are also under the care of at least one other consultant physician or surgeon.  Transfers from other hospitals must be accepted by a medical or surgical team prior to accepting the transfer.  Similarly, all emergency admissions need a named parent consultant before admission to the unit.  Trauma transfers from other hospitals should usually be admitted via the ED so that they can have a repeat trauma call particularly if the injury is recent.