Critical care outreach

You’re in your first week as a first year foundation programme doctor on a busy medical firm. Its 16:50 on Friday, and the senior ward nurse asks you to review a patient whose vital signs have worsened. You arrive at the bedside to find that the patient looks terrible. His blood pressure is not recordable, his pulse is off the chart, and his consciousness is clearly reduced. Your team have all gone home, and the medical and intensive care registrars on-call are stuck in the emergency department. You have never felt more alone. What do you do? The answer may be simple: call critical care outreach.

Critical care outreach teams are becoming ubiquitous in UK hospitals, yet their role, application, and importance are widely misunderstood and underappreciated by medical students and junior doctors. We spoke to Valerie Forde, critical care outreach lead at University Hospital Coventry and Warwickshire, to find out exactly who they are, what their role is, and what help they can provide.

In 2007 73% of acute National Health Service hospitals had a critical care outreach team,1 and the number is increasing. The Department of Health has made developing such services a “highest priority recommendation [to] support ward staff in managing patients at risk,”2 establishing three central aims for outreach services (box 1), and their value is recognised by multiple professional medical bodies.3456 Forde explained the objectives: firstly, the service supports ward teams to manage and stabilise critically ill patients in their current area, to avoid but not preclude the involvement of intensive care. Secondly, she says, “We don’t just help people get into the intensive care unit: we help patients get out and stay out.” And finally, the service aims …