- 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
- 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
Primarily nursing staff the provide these skills:
- advanced tracheostomy management
- 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 of benefit is lacking
- 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- the outreach/ MET culture is sufficiently entrenched that unlikely to be withdrawn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.