Critical care outreach: implementation in a cardiothoracic centre

Introduction

Outreach teams have recently been implemented across the United Kingdom with a remit to deliver a specialist level of assessment and intervention with the ward setting. These goals include early identification of deteriorating patients to avert admission to ICU; facilitating discharge from ICU and education of ward staff.

Objective

An evaluation of a nurse-led outreach team to facilitate the threefold remit of outreach in a specialist cardiothoracic unit.

Methods

Establishment of a unique referral criteria to reflect the specialist cardiothoracic casemix. One hundred per cent of Level 3 discharges are followed up and actively managed to facilitate early discharge (including patient on intermittent haemofiltration, intermittent CPAP, tracheostomies in situ and low levels of inotropic support). Ward-based education programme. Electronic data collection.

Results

Over 800 patients were reviewed over a 12-month period encompassing more than 2000 patient assessments. Level 3 discharge follow-up increased to 100% from 45% prior to establishment of a dedicated team. The overall readmission rate has remained unchanged; however, the readmission rate within 48 hours with organ failure is below 2%, reflecting appropriate discharge from Level 3. Forty-five per cent of patients showed biochemical evidence of renal impairment post ICU discharge requiring a longer stay on outreach.

Conclusion

This evaluation has highlighted the increasing dependency of patients managed outside of ICU. Facilitating ICU discharge and follow-up of patients with renal and respiratory impairment impacts significantly on ICU length of stay.