18. Outreach

Question 1

What levels of care exist with reference to critical care needs

Answer 1

Level 0
Need met thru normal ward care in acute hospital

1
Risk deterioration 
recently relocated higher level care
Needs can be met acute ward
additional advice support from crit care team

Question 2

Level 2

Answer 2

Requiring more detailed observation
intervention

Including support single failing organ system

postop care

those stepping down from higher levels of care

Question 3

Level 3

Answer 3

Patients requiring advanced resp support alone

or asic resp support and support of at least 2 organ system

all complex patients requiring multi organ support for failure

Question 4

Role Outreach team

Answer 4

Developed integral part CC service

Aim provide hospital wide approach to crit illness
collab with other departments

Main objectives

Avoid unnecessary admission

• early recognition those deteriorating
• helping institute approp treatment
• facilitate early ccm admission
  to prevent furth M+M
• Enable CC discharges to ward
  continued support + f/u
• Share crit care skills & expertise w/ multi disc staff on ward
  in community
• Promote continuity of care
• Ensure outreach audit process + feedback establish
  facilitate improved services in future

Question 5

Guidelines- acutely ill patients in hospital

Answer 5

Nice guidelines 07

Physiological observations must be recorded
@ admission / first assessment

Clear plan
regarding frequency and type of obs
according to comorb
diagnosis
rx plan

All acute patients monitored using
track and trigger system
ability increase or decrease frequency of monitoring
as per physiological status

Question 6

Guidelines- acutely ill patients in hospital

Answer 6

Organisation ensure staff adequate + approp training
education / assessment
of performing obs
monitoring
recognition of clinically deteriorating patients

Patients grouped into low med high
risk of deterioration
response by staff according to status

Crit care referrals should be cons-> cons

D/C patients from ccm should ideally be a day light hours

Once d/c decision made
response ward and cc staff ensure safe transfer

structured handover ID further management plans
ability ward to continue rx