Critical care outreach: capturing nurses' contributions

Pattison, Natalie

doi:10.1111/j.1478-5153.2012.00516.x

Cited by 8 publications

(5 citation statements)

References 28 publications

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“…However, neither do the findings suggest a change in practice is warranted as the evidence synthesized is of poor quality and the findings equivocal. Furthermore, this review focused solely on readmission and mortality, and therefore many potential benefits of CCSDPs for patients and nurses identified in wider literature were not considered, including: enhancing nurse confidence in caring for complex patients; alleviating patient anxiety and improving patient safety 51,56 …”

Section: Implications and Recommendationsmentioning

confidence: 99%

Routine critical care step‐down programmes: Systematic review and meta‐analysis

Tanner

Cornish

2020

Nursing in Critical Care

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Background Patients discharged from critical care to general hospital wards are vulnerable to clinical deterioration, critical care readmission, and death. In response, routine critical care stepdown programmes (CCSDPs) have been widely developed, which involve the review of all patients on general wards following discharge from critical care by multidisciplinary Outreach teams with critical care skills. Aims and objectives This review aims to answer the question: do routine CCSDPs reduce readmission and/or mortality among patients discharged from critical care? Design Systematic review of quantitative studies and meta‐analysis. Methods Six databases were comprehensively searched from inception (CENTRAL, Cochrane Reviews, MEDLINE, Embase, CINAHL and web of Science), alongside grey literature and trial registers. Studies investigating the effect of routine CCSDPs delivered by Outreach nurses on readmission and/or mortality following discharge from adult critical care to general hospital wards were included. Study quality was assessed using the Cochrane ROBINS‐I tool. Results Eight studies met the inclusion criteria, with data from 6 studies pooled in 3 meta‐analyses. Among patients exposed to routine CCSDPs, pooled data estimated a statistically nonsignificant reduction in the risk of readmission to critical care (risk ratio [RR] 0.85; 95% confidence interval [CI] 0.66‐1.09; P = .19), a statistically significant increase in the risk of readmission to critical care within 72 hours (RR 1.49; 95% CI 1.05‐2.12; P = .03), a statistically non‐significant reduction in risk of mortality following critical care discharge (RR 0.90; 95% CI 0.75‐1.07; P = .22), and no association with mortality within 14 days of discharge. Conclusion This review is unable to definitively conclude whether routine CCSDPs reduce critical care readmission or mortality following critical care discharge. Relevance to clinical practice While the synthesized evidence does not suggest a change in policy and practice are warranted, neither does it support routine CCSDPs in the absence of high‐quality evidence.

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Section: Implications and Recommendationsmentioning

confidence: 99%

Routine critical care step‐down programmes: Systematic review and meta‐analysis

Tanner

Cornish

2020

Nursing in Critical Care

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“…Nevertheless, these systems or individual components of the systems are parts of modern acute care settings. Some RRTs are nurse‐led, staffed with special trained ICU nurses (Massey et al, 2015 ; Pattison, 2012 ). Pros and cons of nurse‐led versus physician‐led teams have been subjected to research, with equivocal results (Al‐Qahtani et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

“…In North America, Australia and several European countries, Medical Emergency Teams (MET), Rapid Response Teams (RRT) and Critical Care Outreach Teams (CCOT) have been major patient safety strategies in acute care for about two decades (Chan et al, 2010; DeVita et al, 2006; Pattison, 2012). With inspiration from Australia, these different, however very related team, models were introduced into modern hospitals to strengthen the safety net underneath deteriorating general ward patients (DeVita et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Balancing responsibilities, rewards and challenges: A qualitative study illuminating the complexity of being a rapid response team nurse

Bunkenborg

O'Connell

Jensen

et al. 2022

Journal of Clinical Nursing

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Aim and Objective: To explore Rapid Response Team nurses' perceptions of what it means being a Rapid Response Team nurse including their perceptions of the collaborative and organisational aspects of the rapid response team (RRT).Background: For more than 20 years, RRT nurses have been on the frontline of critical situations in acute care hospitals. However, a few studies report nurses' perceptions of their role as RRT nurses, including collaboration with general ward nurses and physicians. This knowledge is important to guide development and adjustment of the RRT to benefit both patients' safety and team members' job satisfaction. Design: Qualitative focus group interviews.Methods: A qualitative approach was applied. Throughout 2018 and across three regions and three acute care settings in Denmark, eight focus group interviews were conducted in which 27 RRT nurses participated. Transcribed interviews were analysed using inductive content analysis. Reporting of this study followed the COREQ checklist.Results: One overarching theme 'Balancing responsibilities, rewards, and challenges' was derived, comprising six categories: 'Becoming, developing and fulfilling the RRT nurse role', 'Helping patients as the core function of RRT', 'The RRT-call at its best', 'The obvious and the subtle RRT tasks', 'Carrying the burden of the RRT', and 'Organisational benefits and barriers for an optimal RRT'. Conclusion:Being a RRT nurse is a complex task. Nurses experience professional satisfaction and find it meaningful helping deteriorating patients. The inadequate resources available to train general ward staff how to manage basic clinical tasks are an added stress to nurses.Relevance to clinical practice: Organisational managers need a better understanding of the necessary staffing requirements to attend patients' needs, train staff and handle the increasing acuity of ward patients. Failure to do so will be detrimental to patient outcomes and compromise RRT nurses' job satisfaction.

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“…Pattisson's guest editorial explores the impact of critical care outreach and the challenge of capturing the added value of nurses' contribution to patient outcomes and well‐being. As Pattison (2012) put it: ‘in the current health care era providing one's worth is an omnipresent issue’. In the situation of critical care outreach, isolating the single variable that can be used to evidence a positive impact becomes problematic.…”

mentioning

confidence: 99%

“…When set beside health economic evaluation, the value of the service is called into question because the methodology deconstructs practice into measurable elements meaningful to an economist. Pattison (2012) demonstrates through her detailed analysis of the situation how in making things measurable one looses sight of why the service is meaningful to a patient who is rapidly deteriorating and to ward staff who need the expert support and advice of the critical care outreach team.…”

mentioning

confidence: 99%

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Scholes¹

2012

Nursing in Critical Care

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Critical care outreach: capturing nurses' contributions

Cited by 8 publications

References 28 publications

Routine critical care step‐down programmes: Systematic review and meta‐analysis

Routine critical care step‐down programmes: Systematic review and meta‐analysis

Balancing responsibilities, rewards and challenges: A qualitative study illuminating the complexity of being a rapid response team nurse

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