Intensive care (ICU / PICU)
The Critical Care area of BridgeERP HMS manages the most acutely ill inpatients — the intensive-care and high-dependency beds where every patient is scored, charted hour-by-hour and reviewed against care bundles. It layers ICU-specific documentation (severity scores, ventilator settings, vasopressor titrations, hourly intake/output, daily goals and family updates) on top of an ICU admission record, and a parallel PICU branch carries the paediatric scoring scales. Intensivists, critical-care nurses and unit managers work here.
Where to find it
Critical care lives under the HMS Core → Wards & Admissions → Critical Care branch:
- Critical Care → Admissions — the ICU admissions, split into Active, Weaning, Step-Down Ready, Discharged and All.
- Critical Care → ICU Census and ICU Dashboard — the live unit picture.
- Critical Care → Severity Scores, Ventilator Settings, Vasopressor Titrations, Drug Charts and I/O Charts (hourly) — the bedside flowsheets.
- Critical Care → Daily Goals, Bundle Compliance, Bundle Performance and Step-Down Plans — the rounds and quality tools.
- Critical Care → Family Updates, Incidents, Mortality Review, Monthly Outcomes and Daily ICU Report — communication, safety and reporting.
- PICU (top menu) — the paediatric scales: PEWS, COMFORT-B, PIM-3, PRISM-III, Fluid Balance and Vent Snapshots.
Before you start
An ICU admission sits on top of the normal inpatient model, so the patient should already have a bed in a critical-care ward (see Wards, rooms & beds). Have the admitting APACHE and SOFA scores ready, and agree the Ceiling of Care with the family and attending intensivist — it is a required clinical decision recorded on the admission.
Admit and run an ICU stay
- Open an ICU admission and select the patient, ward and bed. Set the Admission Category — Post-Operative, Medical Emergency, Trauma, Cardiac, Respiratory Failure or Sepsis / Septic Shock — and name the Attending Intensivist.
- Record the admitting APACHE and SOFA scores and set the Ceiling of Care (for example Full Resuscitation or No CPR / DNACPR). The stay opens in the Admitted state.
- Through the stay, drive the status with the buttons: Mark Critical and Mark Stable reflect the clinical picture; Start Ventilator Weaning and Start Vasopressor Weaning begin the de-escalation; Mark Step-Down Ready signals the patient can leave the unit; Mark Deceased closes a death.
- Chart at the bedside as the shift runs — severity scores, ventilator settings, vasopressor titrations, hourly I/O and drug charts each have their own flowsheet linked to the admission.
- On rounds, complete the Daily Goals (the Complete Round button), review bundle compliance, and log a Family Update.
ICU status flow
The ICU admission walks its own nine-state status, distinct from the general inpatient status:
| Status | Meaning |
|---|---|
| Admitted | Patient newly in the unit. |
| Stable | Clinically stable trajectory. |
| Critical | Deteriorating or unstable. |
| Weaning Ventilator | Active de-escalation of ventilatory support. |
| Weaning Vasopressor | Active de-escalation of vasopressor support. |
| Ready for Step-Down | Cleared to move to a lower level of care. |
| Transferred Out | Left the unit by transfer. |
| Deceased | Closed by patient death. |
| Discharged Against Medical Advice | Patient self-discharged against advice. |
Admission categories
The Admission Category records why the patient needs critical care. It drives case-mix reporting and is chosen from a fixed list:
| Category | Covers |
|---|---|
| Post-Operative | Planned or unplanned post-surgical critical care. |
| Medical Emergency | Acute medical decompensation. |
| Trauma | Major-trauma critical care. |
| Cardiac | Cardiac arrest, ACS, arrhythmia, cardiogenic shock. |
| Respiratory Failure | Type I/II respiratory failure needing support. |
| Sepsis / Septic Shock | Severe sepsis and septic shock. |
| Neurological | Stroke, status epilepticus, raised ICP. |
| Metabolic / Endocrine | DKA, severe electrolyte or endocrine crises. |
| Obstetric / Peripartum | Critical maternal and peripartum care. |
| Other | Any cause not covered above. |
Ceiling of care
The Ceiling of Care is the governing escalation decision agreed with the patient, family and intensivist. Four levels are available:
| Ceiling of Care | Meaning |
|---|---|
| Full Resuscitation | No limits; full escalation including CPR. |
| No CPR (DNACPR) | Active treatment continues but no cardiopulmonary resuscitation. |
| No Escalation of Care | Current treatment maintained but not escalated further. |
| Comfort Care Only | Care focused on symptom relief and dignity. |
Bedside flowsheets
The flowsheets are where critical-care nursing happens. Ventilator Settings capture mode and settings over time; Vasopressor Titrations record infusions, with Stop Infusion to wean off; I/O Charts (hourly) give the hour-by-hour fluid balance; Severity Scores trend the patient against the admitting baseline; Drug Charts hold the critical-care prescriptions. Spontaneous-breathing trials are logged on the ventilator flow with SBT Passed / SBT Failed.
The Severity Scores flowsheet supports the recognised critical-care scoring instruments, several of which calculate automatically from charted values:
| Score | What it measures |
|---|---|
| APACHE II | Acute physiology and chronic-health severity at admission. |
| SOFA | Sequential organ-failure assessment, trended daily. |
| SAPS II | Simplified acute physiology score. |
| Glasgow Coma Scale | Conscious level. |
| MEWS | Modified early-warning score. |
| NEWS2 | National early-warning score 2. |
| SIRS Criteria | Systemic inflammatory response criteria. |
| qSOFA | Quick SOFA for bedside sepsis screening. |
| RASS Sedation | Richmond agitation–sedation scale. |
Rounds, bundles & communication
Daily Goals structure the ward round and are closed with Complete Round. Bundle Compliance tracks the care bundles (e.g. ventilator and line bundles) and Bundle Performance aggregates them. Family Updates record each conversation with relatives, and the admission shows the hours since the last update so no family is left uninformed. Step-Down Plans document the move out of the unit, and Incidents capture safety events.
Paediatric critical care (PICU)
The PICU menu carries the paediatric scoring tools as their own records, each a recognised clinical scale:
- PEWS — Paediatric Early Warning Score.
- COMFORT-B — sedation scoring.
- PIM-3 and PRISM-III — mortality-risk scores.
- Fluid Balance — 24-hour paediatric fluid balance.
- Vent Snapshots — paediatric ventilation setting snapshots.
Field reference
| Field | Meaning | Required |
|---|---|---|
| Patient / Ward / Bed | Who and where in the unit. | Yes |
| Admission Category | Post-op, medical, trauma, cardiac, respiratory, sepsis. | Yes |
| Attending Intensivist | Responsible critical-care doctor. | Recommended |
| Admission APACHE / SOFA | Baseline severity scores at admit. | Recommended |
| Ceiling of Care | Resuscitation limits agreed for this patient. | Yes |
| ICU Status | Admitted → Stable/Critical → Weaning → Step-Down. | Auto |
| Expected LOS (days) | Planned length of stay. | No |
Reports & KPIs
The unit publishes its position through the ICU Dashboard and ICU Census, the Daily ICU Report, Bundle Performance, Monthly Outcomes and Mortality Review. Latest APACHE and SOFA scores and a severity colour are computed on each admission so the census shades the sickest patients automatically.
Tips & troubleshooting
Step-down & outcomes
Getting a patient safely out of the unit is as managed as getting them in. When the clinical picture allows, the intensivist presses Mark Step-Down Ready, which surfaces the patient on the Step-Down Ready admissions worklist and prompts a Step-Down Plan documenting the move to a lower level of care. The Weaning worklists keep the unit’s de-escalation pipeline visible so bed managers can anticipate which critical-care beds are about to free up — the same information the wards need to plan a receiving bed. This tight loop between ICU status and the wider bed map is what keeps a scarce critical-care bed turning over without losing the patient’s thread.
For governance, Mortality Review and Monthly Outcomes aggregate closed stays so the unit can review deaths and length-of-stay trends, while Bundle Performance shows how consistently the care bundles were delivered. Because every flowsheet — severity, ventilator, vasopressor, I/O — is linked to the admission, an audit or mortality review can reconstruct the whole stay from a single record rather than chasing paper charts.
Related
- Wards & Admissions overview
- Admit, transfer & discharge
- Emergency — ICU admissions often arrive from the ED.