Piloting a Nurse-Led Critical Care Outreach Service to Pre-Empt Medical Emergency Team Calls and Facilitate Staff Learning

International Journal of Environmental Research and Public Health · 3 authors, 4 centres

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TL;DR

This pilot study evaluated a nurse-led critical care outreach service (NLCCOS) in two hospital wards, finding that most at-risk patients had compromised respiratory status and nurses reported high satisfaction and learning from the service. The main limitation is the lack of patient outcome data and a convenience sample, so effectiveness remains unproven.

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BACKGROUND

Rapid response systems (RRS) aim to prevent unexpected cardiac arrests and organ failure in hospitalized patients, but effectiveness varies. A nurse-led critical care outreach service (NLCCOS) was piloted to support ward nurses in managing at-risk patients. Methods: This mixed-methods pilot study was conducted in two wards (orthopedic and medical) at a university hospital in Denmark from December 2018 to May 2019. A convenience sample of 100 patients at risk of deterioration was enrolled. Data were collected via Case Report Forms and ward nurse questionnaires. Key Results: Most patients (71%) had compromised respiratory status. Median respiratory rate was 20, and oxygen saturation was 94%. Main educational areas included respiratory therapy, invasive procedures, medications, and mobilization. Limitations: The study used a convenience sample in a single hospital, did not measure patient outcomes, and lacked NEWS scores. Implications: NLCCOS appears feasible and acceptable for supporting ward nurses, but further research is needed to test its effectiveness in randomized trials.

STUDY TYPE

other

SPECIALTY

critical care

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AI pipeline

FIDELITY CHECK

98% · A

ORIGINAL PAPER

PMC10001841

Piloting a Nurse-Led Critical Care Outreach Service to Pre-Empt Medical Emergency Team Calls and Facilitate Staff Learning

International Journal of Environmental Research and Public Health

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ABSTRACT

Abstract A nurse-led critical care outreach service (NLCCOS) can support staff education and decision making in the wards, managing at-risk patients with ward nurses to avoid further deterioration. We aimed to investigate the characteristics of patients identified as at-risk, the types of treatments they required to prevent deterioration, the education initiated by the NLCCOS, and the perceived experiences of ward nurses. This prospective observational pilot study using mixed methods took place in one medical and one surgical ward at a university hospital in Denmark. Participants were patients nominated as at-risk by head nurses in each ward, the ward nurses, and nurses from the NLCCOS. In total, 100 patients were reviewed, 51 medical and 49 surgical patients, over a six-month period. Most patients (70%) visited by the NLCCOS had a compromised respiratory status, and ward nurses received teaching and advice regarding interventions. Sixty-one surveys were collected from ward nurses on their learning experience. Over 90% ( n = 55) of nurses believed they had learned from, and were more confident with, managing patients following the experience. The main educational areas were respiratory therapy, invasive procedures, medications, and benefits of mobilization. Further research needs to measure the impact of the intervention on patient outcomes and MET call frequency over time in larger samples. Keywords: clinical decision making, patient deterioration, rapid response system, nursing, critical care outreach, patient safety, medical emergency team, ICU liaison

CITATION EXPORT

Anja Geisler, Susanne Hedegaard, Tracey K Bucknall. Piloting a Nurse-Led Critical Care Outreach Service to Pre-Empt Medical Emergency Team Calls and Facilitate Staff Learning. International Journal of Environmental Research and Public Health. (2023). https://doi.org/10.3390/ijerph20054214

AUTHORS

3 · 4 CENTRES

Anja Geisler, Susanne Hedegaard, Tracey K Bucknall

1Department of Anesthesiology, Zealand University Hospital, Lykkebaekvej 1, 4600 Koege, Denmark
2Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
3School of Nursing & Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
4Centre for Quality and Patient Safety—Alfred Health Partnership, Institute of Health Transformation, Alfred Health, 55 Commercial Rd, Melbourne, VIC 3004, Australia