After the Referral
Once you have made the referral, document it in the medical notes immediately: the time of the call, who you spoke to, what information you gave, what the ICU team’s response was, and any agreed management plan. This documentation is important both for clinical continuity and for medicolegal purposes.
While awaiting ICU review, continue to manage the patient actively. This means optimising their airway, breathing, and circulation within the limits of your capability, escalating any further deterioration to the ICU team immediately, and ensuring that nursing staff are monitoring the patient continuously and aware of the urgency of the situation. A patient who has been referred to ICU should not be left unmonitored — they should have continuous pulse oximetry and regular blood pressure monitoring as a minimum.
If the patient’s condition deteriorates significantly before the ICU team arrives, call them back. Do not assume that a single call is sufficient if the clinical picture has changed materially.
| Common Referral Mistakes to Avoid • Waiting too long — if you are worried, call. The ICU team would rather hear from you early than receive a crash call • Calling without the observations in front of you — have the chart and blood results ready before you pick up the phone • Burying the lead — say the most urgent thing first, not after two minutes of background history • Failing to state clearly what you want — ‘I just thought you should know’ is not a recommendation • Not documenting the referral — if it isn’t written, it didn’t happen • Assuming the referral means your job is done — continue active management until the ICU team arrives |