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Patient- and relative-activated critical care outreach: a 7-year service review

24 January 2019
Volume 28 · Issue 2


Five years following the introduction of a whole-hospital, 24-hour critical care outreach (CCO) service, an additional service was introduced that enabled patients and their families to directly call the CCO team if they had concerns that were not being acknowledged by the patient's clinical team. The aim of this review was to report on 7 years of patient and family referrals using quantitative and free text data extracted from the CCO referral database. Information on demographics, frequency, nature and reason for the referrals have been reported that highlight the feasibility of such a service, and the potential to prevent patient deterioration. By tapping into the rich source of information from family concerns, future hospital services could be designed that could not only have an impact on patient outcome, but also positively influence the quality of the patient experience.

Various models of rapid response systems (RRSs) have been implemented across a number of countries (DeVita et al 2006; 2010). Using this model, a critical care outreach (CCO) service was implemented in one UK hospital in 2001, and has been operating 24 hours a day, 365 days a year since 2005. Clinical staff can refer patients to CCO if they breach early warning criteria, or if they are concerned about the patient. In 2009 the ‘Call 4 Concern’ (C4C©) service was introduced, which enables patients and their families to call the CCO team directly if they have concerns about the patient that were not being acknowledged by the patient's clinical teams (Odell et al, 2010). This is the first such service provided in the UK and the aim of this review was to report on 7 years of patient- and family-activated CCO to provide data on demographics, frequency and nature of C4C referrals, and report the reasons for the referrals. Demonstrating the feasibility of the service, the impact on prevention of deterioration and meaningful patient and family involvement could encourage other CCO teams to adopt C4C in order to promote better patient outcomes and experiences.

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