PURPOSE: Critical care outreach or rapid response teams have been shown to decrease the number of cardiac arrests in hospital, decrease the number of admissions and to the ICU from the ward and improve access to critical care resources. We implemented a critical care Outreach Team at Toronto East General Hospital, a 500 bed community hospital, as part of a provincial strategy to improve hospital resource allocation.
METHODS: The Ministry of Health of Ontario, through its Critical Care Strategy, provided funding to facilitate the creation of an Outreach Team consisting of a critical care nurse, respiratory therapist and physician. The nursing-led team responds to calls from the inpatient wards. A full patient assessment is completed along with communication with the admitting physician and bedside teaching, if appropriate, with the ward front-line workers. We collected data on patient outcomes, worker satisfaction, re-admission rates to the ICU, cardiac arrests and number of treatments provided on the ward.
RESULTS: From November 2006 to January 2007 a total of 168 patients were seen. All ICU discharges (n=112) were followed and new consults (n=56) were seen by the Outreach Team. Of the new consults 23 were transferred to ICU and 43 remained on the wards. The transfer of these patients was greatly facilitated and the inpatient ward staff was greatly satisfied with the interaction with the Outreach Team. Bedside education, expert resources and better patient-family communication were the most valued features of the team when the in-patient ward staff was surveyed. We noted a tremendous increase in the accessibility of the ICU to the hospital population. We did not, however, notice a decrease in the number of cardiac arrests in the hospital.
CONCLUSION: The Outreach Team greatly improved the quality of care delivered on the inpatient wards, increased the access to the ICU and has provided tremendous bedside teaching to all members of the multidisciplinary team.
CLINICAL IMPLICATIONS: The creation of critical care Outreach Teams improves patient safety and worker satisfaction in a large community hospital.
DISCLOSURE: Carmine Simone, No Financial Disclosure Information; No Product/Research Disclosure Information