Outreach support

Critical care outreach aims to augment the effectiveness of Critical Care Units by utilising their expertise at all stages in the evolution of critical illness. Outreach teams typically support patient care outside the Critical Care Unit to prevent admission or readmission. However, the outreach team will also expedite timely admission to a Critical Care Unit for those that need it. Outreach teams work in collaboration with staff in general ward areas and should be utilised following the identifi cation of a deterioration in the patient’s condition to provide advice, support, education, and a link to the critical care facility. Many outreach teams in the UK are developed around critical care nurses, but they also depend on support from critical care medical staff and other m embers of the multidisciplinary critical care team such as physiotherapists. In other countries such as Australia, the model of a medical emergency team, staffed by intensivists or trainees, is more commonplace.

The outreach team should support and facilitate the ability of ward staff to:

Identify patients who are at risk of developing life-threatening acute illness. Patients suffering cardiorespiratory arrest in hospital usually show gradual deterioration over several hours (especially in conscious level and respiratory rate) rather than an abrupt collapse.

• Initiate immediate resuscitation.

• Make appropriate referral, documentation, and communication.

• Provide psychological support and physiological surveillance to patients after discharge from the Critical Care Unit.

• Educate and train general ward staff in the identifi cation of deteriorating vital signs, the use of appropriate early warning scoring systems, and the institution of appropriate management.

• Though no study has specifi cally shown mortality reduction through the use of outreach or medical emergency team, ward staff and

patients greatly value their support. The outreach teams can prompt decisions regarding resuscitation status and this has led to a reduction in inappropriate cardiac arrest calls.

Outreach team calling criteria

These are usually defi ned locally based on breaching limits of vital signs.

Early warning scoring systems

Simple risk assessment tools are available to aid the identifi cation of patients at risk of deterioration. These are based on weighted scores given to routinely available vital sign data.

Typical outreach calling criteria

• Respiratory rate >25 or <8/min.

• Oxygen saturation <90% on FIO2 >0.35.

• Heart rate >125 or <50 beats/min.

• Systolic blood pressure <90 or >200mmHg, or a sustained fall of >40mmHg from the patient’s normal value.

• Sustained alteration in conscious level.

• Patient looks unwell or you are worried about their condition.