Bridging the gap between the intensive care unit and general wards-the ICU Liaison Nurse.

The acute care system in our public hospitals has seen an increase in acuity for multiday patients with associated pressure on access to the intensive care unit (ICU) beds for both elective and emergency patients. When an ICU bed has not been available at this hospital, it has resulted in elective surgery being cancelled and/or emergency patients requiring an ICU admission being transferred to other hospitals. Apart from the problems either of these situations can cause to patients and their families, both government and hospital managements expect that access to an ICU (or other) bed will be available for patients in our community who require this level of care. To maximise access to our ICU beds it was necessary to ensure that length of stay (LOS) in ICU was kept to the minimum required for each individual patient and that re-admission rates to ICU for preventable complications were reduced. This paper relates our experience of developing and introducing an advanced practice nursing position (the ICU Liaison Nurse) in 1998, to oversee the transition of patients discharged from ICU to the general wards. Between 1997 and 2002 with the development of the ICU Liaison Nurse (ICU LN) post, medical readmissions to ICU were reduced from 2.3 to 0.5%. It is now 5 years since the position was introduced and the role has evolved over this time so that today the ICU LN not only bridges the gap between ICU and ward-based care, but when necessary can be involved in the care of patients on the ward whose condition has deteriorated to the point where transfer into ICU may be necessary.