Critical Care Outreach Service

The Critical Care Outreach Team is a nurse led service that supports ward nurses and doctors who care for the patients at Liverpool Heart & Chest Hospital (LHCH). The Outreach Nurses are all highly experienced Critical Care trained nurses who have also undergone advanced training in patient examination and diagnostics, and some are able to prescribe medication. We take patient referrals 24/7, 365 days a year. The Team has recently expanded to cover night shifts so the staff and patients at LHCH are supported throughout any 24-hour period.

All of LHCH’s patients have their vital signs monitored using a ‘Modified Early Warning Score’ (MEWS). The MEWS system helps staff to recognise quickly if a patient’s condition changes or deteriorates. At LHCH we use the MEWS to ‘trigger’ timely patient reviews, by prompting staff to call doctors and the Outreach Team to assess acutely unwell or deteriorating patients.

The key roles of the Critical Care Outreach team are to:

• Assess acutely ill/deteriorating patients on the wards, and advise and discuss with the patients team regarding monitoring, investigations and management plans. The aim is to investigate, stabilise and improve the patient’s condition on the ward therefore avoiding the need for admission to Critical Care.
• Facilitate safe transfer to Critical Care areas where more specialist management and treatment can be provided. The Outreach Team ensures a timely referral allowing the necessary support to be provided as quickly as possible, and strives to keep the patient and relatives updated at all times.
• Follow up for Critical Care patients when discharged back to the wards. Whilst many patients have little or no memory of their Critical Care stay, others have vivid memories of their treatment including on occasion hallucinations and nightmares. Some also have anxieties regarding their transfer to the wards having been used to 1:1 or 1:2 nursing care. The Outreach Team follow up aims for a seamless transition between Critical Care and the ward and gives us the opportunity to assess the patient’s progress both physically and emotionally.
• Follow up visits and clinic after discharge. Any patients who express anxieties regarding distressing dreams and hallucinations are offered a follow up telephone call after discharge. Here, they are invited back either to clinic with a Consultant Intensivist and Clinical Psychologist and/or to visit the Critical Care Unit with the Outreach Team to discuss how they are getting on, meet nurses and doctors who cared for them and see what the Unit really looks like! Many patients have used this service and it has excellent feedback.
• Education & teaching sessions provide an opportunity for us to share our knowledge and skills with ward staff. This can be at the bedside, on the ward, and in formal education programmes throughout the trust with a particular emphasis on MEWS, sepsis, intravascular devices and tracheostomy care training.

Our ultimate goal is to ensure that patients get the best, appropriate and timely care available on their journey through Liverpool Heart & Chest Hospital.

Key Roles:

• 24/7 service
• Assess acutely ill/deteriorating patients
• Facilitate safe transfer to Critical Care
• Follow up for Critical Care patients
• Follow up visits after discharge
• Education & teaching