Critical care outreach referrals: a mixed‐method investigative study of outcomes and experiences

Abstract

Mapping outreach episodes of care and patient outcomes can help highlight areas for improvement. This study outlines reasons for referral and how outreach can facilitate patient pathways in critical illness.

Early warning systems and rapid response to the deteriorating patient in hospital: A systematic realist review

“…These assessment skills are developed by nurses from knowing the patient and from past experiences which were based on subjective rather than objective criteria (Cioffi 2000b, Mackintosh et al2012. As a result findings suggest that experienced nurses use a complex interaction of intuition, protocols and clinical judgment to recognise patient deterioration and not just the objective MET criteria to refer patients (Pattison &Eastham 2011, Johnston et al 2014. As a result EWS were used flexibly by senior staff to support decision making (Pattison & Eastham 2011, Mackintosh et al 2012, Hands et al 2013.…”

“…Critical care experience in particular was found to improve nurses' knowledge and recognition of deteriorating patients (Thompson et al 2009, Pattison & Eastham 2011. Findings concluded that engagement in deliberate practice is the primary means by which nurses attain expertise (Whyte et al 2009) and that the experience of staff may be fundamental in reducing risk (Wheatley 2006).…”

“…However, nurses were less confident referring calls to medical staff when concerned about a patient as these subjective cues were difficult to communicate (Cioffi et al 2000a, McArthur-Rose 2001, NSPA 2007, required more justification and took time to collect data to place the clinical change in context (Braaten 2015). As a result delays in referral were associated with lack of self efficacy, clinical experience and uncertainty (Massey et al 2014, Roberts et al 2014) and untrained and junior staff (Pattison & Eastham 2011, Ludikhuize et al 2011, Radeschi et al 2015.…”

“…This supportive, educational role by RRTs empowers and supports staff (Stafseth et al 2016), results in timelier organisation of care, provides weight and access to expert help and increases morale (Pattison & Eastham 2011).…”

Negotiating Transitions: Involvement of Critical Care Outreach Teams in End-of-Life Decision Making

“…Previous data showed that 30% of emergency critical care referrals result in the patient being admitted to a critical care unit, with the remainder of the patients either achieving stable condition in a general care area, improving in condition, or being transferred to EOL care. 6 In this study, we also planned to assess longterm mortality outcomes of these EOL patients, as previous data have indicated that EOL patients who are sick enough to be referred to outreach do poorly in 100-day and 6-month outcome data, even if they survived the hospital and/or critical care episode. …”