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Design and implementation of needs-specific critical care response teams


Following the severe acute respiratory syndrome epidemic in Ontario Canada, the Canadian Resuscitation Institute was commissioned by the Ministry of Health and Long-term Care to facilitate the improvement of inhospital emergency preparedness through a System-Level Training Initiative. Objectives for the program were to reduce mortality and improve efficiency of ICU resource use through early identification of patients at risk of deterioration and the provision of rapid resuscitation to abort avoidable ICU admissions. The program was designed to train nonphysician responders (primarily nurses and respiratory therapists) supported by remote physician oversight, especially in centres where ICU-trained physicians were not available.


Following an educational needs assessment of learners, a multicomponent critical care response team (CCRT) training course was developed. The 2-day course consisted of a series of small group, interactive, case-based seminars, high-fidelity simulation training, and the publication of a CCRT Provider Manual and Quick Reference Cards. A database for monitoring the effectiveness and impact of the CCRTs was also developed.


Beginning in October 2005, 24 CCRT physician instructors were trained in one of two streams: (i) simulator instructors with skills in constructive feedback and assessment of crisis management skills; (ii) instructors who further refined the case-based seminars and edited the Quick Reference Cards. Acquisition of equipment, liaisons with participating hospitals and creation of the CCRT database were completed in the spring of 2006. Since June 2006, 12 CCRT courses have been run, and 263 participants have been trained as CCRT Providers (87% nurses, and 13% respiratory therapists). Local hospital implementation and preceptored programs occurred over a 12-week period before CCRTs we made available full time (24/7).


It has been demonstrated that unmet needs in critical care education and training for allied healthcare professionals can be identified and corrected through the development and implementation of a multidisciplinary course designed to facilitate creation of CCRTs in the Province of Ontario. Evaluation of the effectiveness of these teams is ongoing.

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Hodder, R., Fox-Robichaud, A., Wax, R. et al. Design and implementation of needs-specific critical care response teams. Crit Care 11 (Suppl 2), P444 (2007).

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