Critical Care Outreach Teams (critical + care_outreach_team)

Distribution by Scientific Domains


Selected Abstracts


Implementing the severe sepsis care bundles outside the ICU by outreach

NURSING IN CRITICAL CARE, Issue 5 2007
Chris Carter
Abstract Sepsis is not a new challenge facing the health care team, it remains a complex disease, which is difficult to identify and treat. Mortality from sepsis remains high and continues to be a common cause of death among critically ill patients, despite advances in critical care. Sepsis accounts for an estimated 27% of all intensive care admissions in England, Wales and Northern Ireland, and accounted for 46% of all intensive care bed days. Recent research studies and the surviving sepsis campaign have shown that identifying and providing key interventions to patients with severe sepsis and septic shock prior to their admission to the intensive care unit significantly improve outcomes. The aim of this paper was to identify how the Critical Care Outreach Team at one local hospital implemented the severe sepsis resuscitation care bundle for patients in the emergency department (ED) and on the general wards. It will include a presentation on the various ways the team raised the profile of severe sepsis and the care bundle at hospital and at national level. It also includes audit data that have been collected. The results showed that if the resuscitation care bundle was implemented within the first 24 h of hospital admission, mortality was 29%, whereas if the care bundle was instigated after this time mortality was more than at 49%. Audit data showed that the commonest sign of severe sepsis seen in patients in the ED and on wards was tachypnoea. This article discusses the successful implementation of the severe sepsis resuscitation care bundle and the positive impact an Outreach team can have in changing practice in the way patients are managed with severe sepsis. The audit data support the need for regular physiological observations and the use of a Patient At Risk Trigger scoring tool to identify patients at risk of deterioration. This allows referral to the Outreach team, who assess the patient and if appropriate initiate the care bundle. [source]


Crossing boundaries, re-defining care: the role of the critical care outreach team

JOURNAL OF CLINICAL NURSING, Issue 3 2002
MAUREEN COOMBS BSc MSc PhD RN
,,There is clear indication that both government and professional policy in the United Kingdom supports a radical change in the role of healthcare practitioners, with a move towards a patient-focused service delivered by clinical teams working effectively together. ,,Recent health service imperatives driving the agenda for flexible clinical teams have occurred simultaneously with an increased public and political awareness of deficits in availability of critical care services. ,,Against this policy backdrop, working across professional and organizational boundaries is fundamental to supporting quality service improvements. In the acute care sector, the development of critical care outreach teams is an innovation that seeks to challenge the traditional support available for sick ward patients. ,,Activity data and observations from the first 6-month evaluation of two critical care outreach teams identify the need for clinical support and education offered by critical care practitioners to ward-based teams. ,,The experiences from such flexible clinical teams provides a foundation from which to explore key issues for intradisciplinary and interdisciplinary working across clinical areas and organizational boundaries. ,,Adopting innovative approaches to care delivery, such as critical care outreach teams, can enable clinical teams and NHS trusts to work together to improve the quality of care for acutely ill patients, support clinical practitioners working with this client group, and develop proactive service planning. [source]


Nurses' role in detecting deterioration in ward patients: systematic literature review

JOURNAL OF ADVANCED NURSING, Issue 10 2009
Mandy Odell
Abstract Title.,Nurses' role in detecting deterioration in ward patients: systematic literature review. Aim., This paper is a report of a review conducted to identify and critically evaluate research investigating nursing practice in detecting and managing deteriorating general ward patients. Background., Failure to recognize or act on deterioration of general ward patients has resulted in the implementation of early warning scoring systems and critical care outreach teams. The evidence of effectiveness of these systems is unclear. Possible mechanisms for low effectiveness may be inconsistent recording of patient observations by ward staff, or inconsistent application of ,calling criteria' for outreach teams, even when observations have been recorded. Methods., The literature was searched between 1990 and 2007 using four sources: electronic databases, reference lists, key reports and experts in the field. Three broad search categories were used: nursing observations, physiological deterioration and general ward patients. All research designs describing nursing observations (vital signs) on deteriorating adult patients in general hospital wards were included. Results., Fourteen studies met the inclusion and quality criteria. The findings were grouped into four main themes: recognition; recording and reviewing; reporting; and responding and rescuing. The main findings suggest that intuition plays an important part in nurses' detection of deterioration, and vital signs are used to validate intuitive feelings. The process is highly complex and influenced by many factors, including the experience and education of bedside nurses and their relationship with medical staff. Conclusion., Greater understanding of the context within which deterioration is detected and reported will facilitate the design of more effective education and support systems. [source]


Crossing boundaries, re-defining care: the role of the critical care outreach team

JOURNAL OF CLINICAL NURSING, Issue 3 2002
MAUREEN COOMBS BSc MSc PhD RN
,,There is clear indication that both government and professional policy in the United Kingdom supports a radical change in the role of healthcare practitioners, with a move towards a patient-focused service delivered by clinical teams working effectively together. ,,Recent health service imperatives driving the agenda for flexible clinical teams have occurred simultaneously with an increased public and political awareness of deficits in availability of critical care services. ,,Against this policy backdrop, working across professional and organizational boundaries is fundamental to supporting quality service improvements. In the acute care sector, the development of critical care outreach teams is an innovation that seeks to challenge the traditional support available for sick ward patients. ,,Activity data and observations from the first 6-month evaluation of two critical care outreach teams identify the need for clinical support and education offered by critical care practitioners to ward-based teams. ,,The experiences from such flexible clinical teams provides a foundation from which to explore key issues for intradisciplinary and interdisciplinary working across clinical areas and organizational boundaries. ,,Adopting innovative approaches to care delivery, such as critical care outreach teams, can enable clinical teams and NHS trusts to work together to improve the quality of care for acutely ill patients, support clinical practitioners working with this client group, and develop proactive service planning. [source]


Physiological risk factors, early warning scoring systems and organizational changes

NURSING IN CRITICAL CARE, Issue 5 2007
Carolyn C Johnstone
Abstract Currently, medical and surgical wards tend to have a higher number of sicker and more dependent patients. There is also a growing recognition that several indicators of acute deterioration are being missed, leading to adverse consequences for the patients. As a result, many initiatives have been designed to try to reduce these consequences, including the development of early warning scoring or track and trigger systems and medical response and critical care outreach teams. This paper briefly discusses the risk factors associated with acute deterioration, the use of early warning scoring or track and trigger systems and the role of outreach teams. The aim of this paper is to discuss the development and subsequent implementation of early warning scoring systems (EWS) or track and trigger systems. It will also discuss the associated organizational changes; the main organizational change discussed will be the introduction outreach teams. For this paper, a pragmatic search strategy was implemented using the following terms: early warning score and scoring, track and trigger systems, decision-making tools, critical care outreach and medical emergency teams. The databases used included CINHAL (1997,2007), Medline, Blackwell Synergy and Science Direct, as these would enable the retrieval of relevant literature in the area of triggering of response to acute deterioration in clinical condition. A 10-year limit was initially set, although review of the literature identified resulted in a widening of this to include some of the relevant (and occasionally more dated) literature referred to in these papers. A total of 645 were accessed; of these 135 were retrieved as they appeared to meet the inclusion criteria, but only 35 have been included in this review. The term decision-making tools accounted for the largest number (500), but most of these were irrelevant. EWS are not always used to their full potential, raising the question of their impact. The impact of outreach teams and medical emergency teams has yet to be fully defined. For clinical practice, this means that care must be taken when developing and implementing these changes. The rigour of the development process needs to be considered along with reflection upon how to best meet local requirements. [source]