ICU Outreach

OVERVIEW

• critical care outreach teams (CCOTs) are becoming more widespread
• CCOT services were developed to meet the actual or potential needs of patients through critical care provision ‘without walls’
• Various models of outreach team exist, from a sole nurse to a multidisciplinary team
• may cross-over with MET teams and/or post-ICU follow up teams

PURPOSE

• Avert critical care admission where possible
• Facilitate timely critical care admission when appropriate
• Empower all health care staff by disseminating ward- based critical care skills
• Optimise patient management and make best use of critical care resources via effective clinical decision-making

SKILLS Primarily nursing staff the provide these skills:

• advanced tracheostomy management
• cannulation
• venepuncture
• prescription via patient group directions
• arterial blood gas sampling
• drug administration
• advanced life support
• management of central/peripheral lines
• 12-lead ECG interpretation
• ordering/interpreting blood results and chest X-rays

EVIDENCE

• evidence of benefit is lacking

CONTROVERSIES

• concerns that ward staff are becoming de-skilled while the workload for intensive care personnel has increased
• diversion of skilled staff away from the ICU to populate CCOTs
• cost-effectiveness unclear
• the outreach/ MET culture is sufficiently entrenched that unlikely to be withdrawn

References and Links

• Cuthbertson BH. The impact of critical care outreach: is there one? Crit Care. 2007;11(6):179. Review. PubMed PMID: 18086323; PubMed Central PMCID: PMC2246212.
• Department of Health. Comprehensive Critical Care: A Review of Adult Critical Care Services. London: Department of Health; 2002.
• Marsh S, Pittard A. Outreach: ‘the past, present, and future’ Contin Educ Anaesth Crit Care Pain (2012) doi: 10.1093/bjaceaccp/mkr062 [Free Full Text]
• Rowe K, Fletcher SJ. Critical care outreach: a review of current practice and evidence. Acute Med. 2010;9(1):8-12. PubMed PMID: 21597560.
• Wood D. Designing an outreach service. In: Cutler L, Robson W (eds) Critical Care Outreach. Chichester: John Wiley; 2006: 13–30.