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You are here: Our Services > Critical Care Centre >Critical Care Outreach

Critical Care Outreach

Critical care outreach is part of a new approach to the management of all critically ill patients not matter where they are within the trust. Previously, critical care largely developed within discrete departments, often quite separate from other clinical areas. It is now evident that there are many at-risk and deteriorating patients on general wards who also need critical care. A review of 1,873 ward patients in 4 trusts found 12.2% of patients required care above 'normal/ward level' (Chellel et al 2002). Such patients often have poor outcomes, although their problems are potentially avoidable (McQuillan et al 1998, Goldhill and Sumner 1998, McGolin et al 1999). In order to address this, the 'Comprehensive Critical care' document (May 2000) recommended the development of critical care outreach teams. They identified three main aims for outreach services:

• To avert admissions - or to ensure that admissions are timely - by identifying patients who are deteriorating
• To enable ICU discharges
• To share critical care skills

In essence, outreach may be viewed as an organisational approach to ensure equity of care for all critically ill patients, irrespective of their location. The Intensive Care Society welcomed these new teams and emphasised that Outreach should be a collaboration and partnership between the intensive care department and other departments to ensure a continuum of care for patients regardless of location, and should enhance the skills and understanding of all staff in the delivery of critical care. This underpins our philosophy here at Hinchingbrooke.

What service do we provide

• Use of a track and trigger system - MEWS which helps nurse to identify sick patients.
• Support and advice to ward staff in the management of the acutely ill patient. Advice is particularly around fluid management and oxygen therapy.
• Facilitating appropriate admission to the Critical Care Centre and continuously liaise with critical care regarding potential admissions.
• Direct patient care and clinical interventions when necessary.
• Ensuring safe transfer of patient's intra-hospital.
• Critical care education and training. Bedside teaching is on-going, working with staff in order to demonstrate critical care skills, acting as mentors and coaches.
• Follow-up service for post ICU patients, including follow-up clinics in order to address both physical and psychological problems. These clinics are held 2,6, and 9 months after the patient is discharged from hospital.
• Part of the cardiac arrest team and suspected MI response team
• Outreach can make a direct referral to the Consultant Anaesthetist in a peri-arrest situation.
• Promote quality and continuity of care for all acutely ill patients regardless of location

Critical care follow-up clinic and rehabilitation

The UK Intensive Care National Audit and Research Centre (ICNARC) estimate that 110,000 people are admitted to critical care units in England and Wales each year. However, until recently there has been little or no support for these people post discharge from the critical care centre. Problems experienced can be physical as well as psychological, often putting strain on relationships with family and friends.
 
Following the release of the NICE guidelines ‘Rehabilitation after critical illness’, the critical care outreach team have developed a follow-up service for post critical care patients. This clinic is run by Dr Koshy who is a consultant anaesthetist working in the critical care centre.

The patients are seen at 2 months, 6 months and 12 months following discharge home, covering their progress for a year post critical illness. Advice and referrals can be made following these clinic sessions to ensure continuation of care into the community.

The follow-up clinic has been running now for a year and already the patient benefits are evident. Hinchingbrooke was awarded ‘Clinic of the Month’ in February by the Intensive Care After Care Network, the national network of follow-up/rehabilitation services.

Contact details

The service at Hinchingbrooke is run 7 days a week (weekends and bank holidays included), from 08:00 - 20:00. A handover takes place every evening so patients can still be followed up.

We are contactable on Bleep 1138

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