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- the outreach/ MET culture is sufficiently entrenched that unlikely to be withdrawn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.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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