What was this study about?
In 2000, as part of its “vision for future critical care services”, the Department of Health promoted the establishment of critical care outreach services. These teams, usually led by experienced critical care nurses, aim to: help staff on general wards identify deteriorating patients; provide advice or treatment; ensure swift admission into a critical care unit; and share skills.
Physiological track and trigger warning systems have been developed for use outside critical care areas with the objective of ensuring timely recognition of deteriorating patients. These track and trigger systems use periodic observation of basic vital signs (heart rate, blood pressure, etc.) together with pre-determined criteria for requesting the attendance of more experienced staff, usually the critical care outreach service.
The aims of the evaluation of critical care outreach services were: to explore the existing evidence for critical care outreach services; to describe their introduction, implementation and models of delivery across the NHS; and to explore and evaluate their impact using both quantitative and qualitative methods.
The aims of the evaluation of physiological track and trigger warning systems were: to describe the existing information on the development and testing of track and trigger systems; to describe their introduction and use across the NHS; to review their validity and utility and evaluate their reproducibility; and to elicit stakeholders’ views.
What did the study find?
Critical care outreach services are being delivered in many different ways across the NHS, appearing to fill gaps according to local need. Although associations were observed with characteristics of patients admitted to critical care units, there was no clear evidence that critical care outreach services have a big impact on the outcomes of these patients, or for characteristics of what should form the optimal model of delivery.
Physiological track and trigger warning systems will not identify all deteriorating patients and should be used as an aide to clinical judgement and experience. However, accurate use of a track and trigger system and response algorithm may improve the pathway of care for recognition and management of acutely ill patients on the general ward.
The results of this study informed the development of the National Institute for Health and Care Excellence clinical guideline on recognition of and response to acute illness in adults in hospital (NICE CG50).
Who led the study?
Professor Kathy Rowan, ICNARC
The study was funded by the NIHR Service Delivery and Organisation (SDO) Programme (Project: 74/2004)