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Investigating the effectiveness of critical care outreach services: a systematic review

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Abstract

Objective

We explored the impact of critical care outreach activity on patient and service outcomes and aimed to contribute to developing a typology of critical care outreach services.

Design

Following a sample search of Medline 15 relevant electronic databases were systematically searched from 1996 to 2004. Searches for publications from nine key authors and citations of eight key articles were performed. Hand searches of journals, bibliographies of reports and review articles, and conference abstracts were conducted. Relevant experts were contacted. A further two studies published after the review date were also included. Two reviewers assessed studies for inclusion, conducted quality assessment and extracted data. Data were synthesised using narrative techniques.

Measurements and results

Seventeen papers and six brief reports were selected for inclusion from a list of 1,760 titles. As anticipated with a relatively new service such as critical care outreach, there were few controlled trials. There were two randomised controlled trials, 16 uncontrolled before and after studies, three quasi-experimental studies, one controlled before and after study and one post-only controlled study. The most frequent outcomes measured were mortality, cardiac arrest, unplanned critical care admissions from wards, length of stay, and critical care readmission rates.

Conclusions

Although improvements in patient outcomes were found, the evidence in this review is insufficient to demonstrate this conclusively. The many differences in service delivery do not permit identification of service typology. Our findings point to a need for more comprehensive research of this expanding service in the United Kingdom.

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References

  1. Department of Health (2000) Comprehensive critical care: a review of adult critical care services. Department of Health, London

    Google Scholar 

  2. National Health Service Modernisation Agency (2003) Critical care outreach. Progress in developing services. Department of Health, London

    Google Scholar 

  3. Department of Health and NHS Modernisation Agency (2002) National outreach survey. Department of Health and Modernisation Agency Survey, London

    Google Scholar 

  4. McDonnell A, Esmonde L, Ball C, Waskett C, Morgan R, Rashidian A, Bray K, Adam S, Harvey S (2006) The effectiveness of critical care outreach services: a systematic review. Presented at the RCN International Nursing Research Conference, 21–24 March

  5. Cuthbertson BH (2003) Outreach critical care — cash for no questions? Br J Anaesth 90:4–6

    PubMed  CAS  Google Scholar 

  6. Goldhill D, McGinley A (2002) Outreach critical care. Anaesthesia 57:183–183

    PubMed  CAS  Google Scholar 

  7. Goldhill DR, Worthington L, Mulcahy A, Tarling M, Sumner A (1999) The patient-at-risk team: identifying and managing seriously ill ward patients. Anaesthesia 54:853–860

    Article  PubMed  CAS  Google Scholar 

  8. Hillman K (2002) Critical care without walls. Curr Opin Crit Care 8:594–599

    Article  PubMed  Google Scholar 

  9. Lee A, Bishop G, Hillman KM, Daffurn K (1995) The medical emergency team. Anaesth Intensive Care 23:183–186

    PubMed  CAS  Google Scholar 

  10. Pittard AJ (2003) Out of our reach? Assessing the impact of introducing a critical care outreach service. Anaesthesia 58:882–885

    Article  PubMed  CAS  Google Scholar 

  11. Ball C, Kirkby M, Williams S (2003) Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study. BMJ 327:1014

    Article  PubMed  Google Scholar 

  12. Leary T, Ridley S (2003) Impact of an outreach team on re-admissions to a critical care unit. Anaesthesia 58:328–332

    Article  PubMed  CAS  Google Scholar 

  13. Intensive Care Society (2002) Guidelines for the introduction of outreach services. Intensive Care Society, London

    Google Scholar 

  14. Royal College of Physicians (2002) Interface between acute general medicine and critical care. Royal College of Physicians, London

    Google Scholar 

  15. Audit Commission (1999) Critical to success: the place of efficient and effective critical care services within the acute hospital. Audit Commission, London

    Google Scholar 

  16. Ball C (2002) Critical care outreach services-do they make a difference? Intensive Crit Care Nurs 18:257–260

    Article  PubMed  Google Scholar 

  17. Bright D, Walker W, Bion J (2004) Clinical review: outreach — a strategy for improving the care of the acutely ill hospitalized patient. Crit Care 8:33–40

    Article  PubMed  Google Scholar 

  18. Goldhill DR (2001) The critically ill: following your MEWS. QJM Monthly J Assoc Phys 94:507–510

    CAS  Google Scholar 

  19. McArthur-Rouse F (2001) Critical care outreach services and early warning scoring systems: a review of the literature. J Adv Nurs 36:696–704

    Article  PubMed  CAS  Google Scholar 

  20. Parr M (2004) Critical care outreach: some answers, more questions. Intensive Care Med 30:1261–1262

    Article  PubMed  Google Scholar 

  21. Robson WP (2002) An evaluation of the evidence base related to critical care outreach teams — 2 years on from comprehensive critical care. Intensive Crit Care Nurs 18:211–218

    Article  PubMed  Google Scholar 

  22. Scales DC, Abrahamson S, Brunet F, Fowler R, Costello J, Granton JT, McCarthy MK, Sibbald WJ, Slutsky AS (2003) The ICU outreach team. J Crit Care 18:95–106

    Article  PubMed  Google Scholar 

  23. Welch J (2004) Critical care outreach-the story so far. Intensive Crit Care Nurs 20:1–5

    Article  PubMed  Google Scholar 

  24. Cretikos M, Hillman K (2003) The medical emergency team: does it really make a difference? Intern Med J 33:511–514

    PubMed  CAS  Google Scholar 

  25. Goldhill DR, McNarry A (2002) Intensive care outreach services. Curr Anaesth Cri Care 13(6):356–361

    Article  Google Scholar 

  26. Thomas H (2003) Quality assessment tool for quantitative studies. Effective Public Health Practice Project. McMaster University, Toronto

    Google Scholar 

  27. McDonnell A (2004) A retrospective observational study of the impact of acute pain teams on patient outcomes. Thesis, University of Sheffield

    Google Scholar 

  28. MERIT Study investigators (2005) Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 365:2091–2097

    Article  Google Scholar 

  29. Norwood MGA, Spiers P, Bailiss J, Sayers RD (2005) Evaluation of the role of a specialist tracheostomy service. From critical care to outreach and beyond. Postgrad Med 80:478–480

    Article  Google Scholar 

  30. Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H, Silvester W, Doolan L, Gutteridge G (2003) A prospective before-and-after trial of a medical emergency team. Med J Aust 179:283–287

    PubMed  Google Scholar 

  31. Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart G, Opdam H, Silvester W, Doolan L, Gutteridge G (2004) Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med 32:916–921

    Article  PubMed  Google Scholar 

  32. Priestley G, Watson W, Rashidian A, Mozley C, Russell D, Wilson J, Cope J, Hart D, Kay D, Cowley K, Pateraki J (2004) Introducing critical care outreach: a ward-randomised trial of phased introduction in a general hospital. Intensive Care Med 30:1398–1404

    Article  PubMed  Google Scholar 

  33. Salamonson Y, Kariyawasam A, van Heere B, O'Connor C (2001) The evolutionary process of medical emergency team (MET) implementation: reduction in unanticipated ICU transfers. Resuscitation 49:135–141

    Article  PubMed  CAS  Google Scholar 

  34. Haji-Michael P, Epstein J, McLellan J, Kapila I, Tansey D, Chopra R (2004) Critical care outreach improves outcome of haematological oncology patients needing critical care admission. Br J Anaesth 94:612

    Google Scholar 

  35. Bristow PJ, Hillman KM, Chey T, Daffurn K, Jacques TC, Norman SL, Bishop GF, Simmons EG (2000) Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team. Med J Aust 173:236–240

    PubMed  CAS  Google Scholar 

  36. Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV (2002) Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ 324:387–390

    Article  PubMed  Google Scholar 

  37. Story DA, Shelton AC, Poustie SJ, Colin-Thome NJ, McNicol PL (2004) The effect of critical care outreach on postoperative serious adverse events. Anaesthesia 59:762–766

    Article  PubMed  CAS  Google Scholar 

  38. Subbe CP, Davies RG, Williams E, Rutherford P, Gemmell L (2003) Effect of introducing the Modified Early Warning score on clinical outcomes, cardio-pulmonary arrests and intensive care utilisation in acute medical admissions. Anaesthesia 58:797–802

    Article  PubMed  CAS  Google Scholar 

  39. Devita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL (2004) Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care 13:251–254

    Article  PubMed  CAS  Google Scholar 

  40. Barnes RJ, Rechner IJ, Odell M, Fielden JM, Even T, Kapila A (2003) Impact of Outreach on emergency surgical admissions to an intensive care unit. Br J Anaesth 90:544P–545P

    Google Scholar 

  41. Durham LD (2004) The effect of introduction of a critical care outreach team on cardiac arrest calls in a district general hospital. Presented at the Intensive Care Society State of the Art Meeting, London, vol. 1, pp 62

  42. Garcea G, Thomasset S, McClelland L, Leslie A, Berry DP (2004) Impact of a critical care outreach team on critical care readmissions and mortality. Acta Anaesthesiol Scand 48:1096–1100

    Article  PubMed  CAS  Google Scholar 

  43. Ricketts J, Cox D (2004) The effect of introducing a critical care outreach team on intensive care admission, readmission and discharge. Presented at the NOREC Conference, London

  44. Kenward G, Castle N, Hodgetts T, Shaikh L (2004) Evaluation of a medical emergency team one year after implementation. Resuscitation 61:257–263

    Article  PubMed  Google Scholar 

  45. Mercer M (2004) Evaluating the impact of an outreach service on case mix adjusted hospital wide rates of death, cardiorespiratory arrest and unanticipated critical care admissions. Presented at the National Outreach Forum Conference, London

  46. NHS Centre for Reviews and Dissemination (2001) Undertaking systematic reviews of research on effectiveness. NHS Centre for Reviews and Dissemination, York

    Google Scholar 

  47. Scherer RW, Dickerson K, Langenberg P (1994) Full publication of results initially presented in abstracts. A meta-analysis. JAMA 272:158–162

    Article  PubMed  CAS  Google Scholar 

  48. Obulon A, Walia R (1999) Differences between information provided in abstracts of randomized controlled trials in neonates submitted to the Annual Meeting of the American Pediatric Society and Society for Pediatric Research (APS/SPR) and final publications-implications for meta-analyses. Presented at the 7th Annual Cochrane Colloquim, Rome

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Acknowledgements

We thank the Steering Group members and the authors who kindly supplied copies of the papers and reports provided. This systematic review forms part of a wider study designed to evaluate CCOSs. This is funded by the NHS R&D Service Delivery and Organisation Programme.

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Correspondence to Lisa Esmonde.

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Esmonde, L., McDonnell, A., Ball, C. et al. Investigating the effectiveness of critical care outreach services: a systematic review. Intensive Care Med 32, 1713–1721 (2006). https://doi.org/10.1007/s00134-006-0380-6

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  • DOI: https://doi.org/10.1007/s00134-006-0380-6

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