Making appropriate decisions about admission to critical care: the role of critical care outreach and medical emergency teams

This chapter discusses ICU organization and management and includes discussion on consent on the ICU, rationing in critical care, ICU layout, medical staffing, ICU staffing (both nursing and staffing for supporting professions), fire safety in the ICU, legal issues and the Coroner, patient safety, Severity of Illness Scoring systems, comparison of ICUs, critical care disaster planning, health technology assessment, transfer of the critically ill patient, aeromedical evacuation, outreach and medical emergency teams, critical care follow-up, rehabilitation, and managing antibiotic resistance.

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Do surgeons need to look after unwell patients? The role of medical emergency teams

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.2005.03480.x ◽

2005 ◽

Vol 75 (10) ◽

pp. 848-851 ◽

Cited By ~ 7

Author(s):

Kenneth Wong ◽

Richard D. Levy

Keyword(s):

Medical Emergency ◽

Medical Emergency Teams

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Outcomes in patients with acute kidney injury reviewed by Critical Care Outreach: What is the role of the National Early Warning Score?

Journal of the Intensive Care Society ◽

10.1177/1751143717715968 ◽

2017 ◽

Vol 18 (4) ◽

pp. 300-309 ◽

Cited By ~ 1

Author(s):

Daniel A Potter ◽

Nicholas Wroe ◽

Helen Redhead ◽

Andrew JP Lewington

Keyword(s):

Acute Kidney Injury ◽

Critical Care ◽

Early Warning ◽

Kidney Injury ◽

Early Warning Score ◽

Acute Kidney Injury Stage ◽

National Early Warning Score ◽

One Year ◽

Critical Care Outreach

Introduction This study investigated outcomes in critically unwell acute kidney injury patients and the role of the National Early Warning Score and other factors in identifying patients who experience negative outcomes. Methods Retrospective cohort study investigating 64 patients seen by Critical Care Outreach between November 2014 and February 2015. Mortality at one year was analysed using multivariate regression; all other statistical tests were non-parametric. Results Forty-four per cent of patients required escalation to higher level care, 56% failed to survive beyond one year and 30% of those who did survive had a deterioration in renal function. Previous acute kidney injury significantly predicted mortality but the National Early Warning Score did not. A subgroup of patients developed Stage 3 acute kidney injury before a rise in National Early Warning Score. Conclusions Acute kidney injury in the Critical Care Outreach patient population is associated with high morbidity and mortality. Previous acute kidney injury and acute kidney injury stage may be superior to the National Early Warning Score at identifying patients in need of Critical Care Outreach review.

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

Journal of Clinical Nursing ◽

10.1046/j.1365-2702.2002.00625.x ◽

2002 ◽

Vol 11 (3) ◽

pp. 387-393 ◽

Cited By ~ 44

Author(s):

MAUREEN COOMBS ◽

ANN DILLON

Keyword(s):

Critical Care ◽

Outreach Team ◽

Critical Care Outreach

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Features and perceptions of a critical care outreach physician role

Critical Care and Resuscitation ◽

10.51893/2021.3.oa1 ◽

2021 ◽

Vol 23 (3) ◽

pp. 248-253

Author(s):

Keyword(s):

Critical Care ◽

Medical Emergency Team ◽

Emergency Department Visits ◽

Medical Emergency ◽

Emergency Team ◽

Role Design ◽

Physician Role ◽

High Level ◽

Survey Responses ◽

Critical Care Outreach

OBJECTIVE: To describe the tasks completed by the critical care outreach physician (CCOP) and staff perceptions of the CCOP role. DESIGN: Prospective observational study and survey of intensive care unit (ICU) staff. SETTING: University-affiliated teaching hospital in Australia. PARTICIPANTS: ICU consultants, registrars and nurses. INTERVENTIONS: Implementing a dedicated ICU consultant to review deteriorating patients outside the ICU. MAIN OUTCOME MEASURES: Prospective collection of CCOP tasks and survey of ICU staff. RESULTS: During 101 clinical shifts, the CCOP had 1524 encounters (mean, 15.1 [standard deviation, 6.1]; median, 14 [interquartile range, 10–19] per day). The three commonest interventions were emergency department visits, direct consultant communication, and coordinating ICU admissions. Involvement in Medical Emergency Team (MET) calls, expediting patient care, and goals of care discussions were also relatively common. Survey responses were obtained from 55/84 (66%) eligible participants. Most respondents thought the CCOP would improve the predefined processes of care and patient-centred outcomes. The areas of greatest perceived benefit included supporting the MET registrar and coordinating simultaneous emergencies outside the ICU. Areas where the role was perceived to be less beneficial included improving handover, identifying patients at clinical risk outside the ICU, and reducing repeat MET calls. CONCLUSIONS: The tasks of a CCOP involved high level communication, coordination of care, and supervision of ICU staff. The effect of this role on patient-centred outcomes requires further research.

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