Do nurse‐led critical care outreach services impact inpatient mortality rates?

Abstract

Background: Previous systematic reviews have assessed the effect of critical care outreach services, but none have focused solely on nurse-led services. Aim: To perform a systematic review examining the impact of nurse-led critical care outreach services on inpatient mortality rates as the primary outcome. Secondary outcomes include arrest call rates and patient length of stay. Methods: A comprehensive search of several electronic databases was carried out, including the Cumulative Index to Nursing and Allied Health Literature and Medline. Non-catalogued literature was searched, and contact was made by e-mail with expert authors. All studies were in the English language, and although heterogeneous in design, only quantitative data were extracted for analysis. All included studies were assessed for quality using recognized quality appraisal tools. Meta-analysis was not possible because of heterogeneity. Results: Ten studies involving almost 72 000 participants were identified. The reduction in mortality rates with nurse-led critical care outreach services was reported to be 80%, but the statistical significance was low -four studies showed reductions ranging from 0⋅1% to 0⋅22%. Greater statistical significance was reported in arrest call rates, with two studies claiming decreased rates of 58⋅7% and 29⋅6%. Two studies reported a decrease in patient length of stay -the findings of a third study were equivocal. Half of the included studies scored poorly in terms of quality and validity, and all were single-centre studies, thereby limiting generalisability. Conclusion: Nurse-led critical care outreach services demonstrate benefits in terms of patient care and reduction in adverse events. Higher-quality research, including multicentre randomized controlled trials, with meta-analysis is recommended. Relevance to clinical practice: Nurse-led critical care outreach services have the potential to improve patient outcomes. Uniformity of team composition and nomenclature would benefit data collection and reporting.

Introduction of rapid response teams in Poland

“…request for help concerning a tracheostomy patient requiring non-invasive mechanical ventilation, too frequent alarms of devices, difficulties in providing a vascular access), a suitably trained nurse or RRT's paramedic can be sent to the ward; depending of the patient's condition and the extent of interventions needed, they can provide appropriate help on the spot or call for a RRT physician. Such a solution successfully functions in some hospital involved in the project and the literature data have confirmed its effectiveness and safety [5]. Moreover, the leading role of the nursing staff in RRTs has been a standard in many healthcare systems in the West [6].…”

A practical approach to establishing a critical care outreach service: An expert panel research design

“…The literature uses multiple terms to describe nurses working within a CCOS including critical care outreach nurses (CCONs), 6 intensive care outreach nurses, intensive care liaison nurses, 7e9 patient-at-risk team nurses, 10 or in some hospitals, the after-hours clinical team co-ordinator. 3 The composition of CCOSs also vary, ranging from typically critical care registered nurse responders through to advanced practice providers (APPs), such as nurse practitioners and nurse consultants.…”

“…3 The composition of CCOSs also vary, ranging from typically critical care registered nurse responders through to advanced practice providers (APPs), such as nurse practitioners and nurse consultants. 5,6,11,12 Increasingly APPs are working within CCOSs and add value to the team by providing diagnostic and treatment expertise, facilitating transfer to the ICU, and improving team communication and education. 13 Internationally, established CCOSs improve patient outcomes.…”

Comparison of clinical outcomes between nurse practitioner and registrar-led medical emergency teams: a propensity-matched analysis

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